HomeMy WebLinkAboutILIAMNA ACRES TR 4Biii,oarnna Acres
Lot Tract 4B
#017-101-21
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241333 PID Number: 017-101-21
Dwelling: ■❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Gary Frederick &Diane Wink
ABSORPTION FIELD
eep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
5401 Riverton Ave, Anchorage, AK, 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from origi rade
t.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Iliamna Acres Track 4B
Fill added above original grade
Ft.
vel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Di ce between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between ches
From
Tank
Field
Tank
Line
Ftz
t.
Well
>100'
N/A
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
>100'
N/A
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
N/A
N/A
N/A
NA
Foundation
>10'
N/A
N/A
N/A
LIFT STATION
acturer Capacity
Gal.
Remarks Deep burial tank
CO's and MT's replaced/repaired in the field
Alarm location nstalled by
PIPE MATERIAL House to tank Tank to
D3034 drainfield D3034
Installer
Northern Excavation
Drainfield N/A Co/MT D3034
Inspector J Earls
BENCH MARK (Assumed elevation) 100.0 ft
Inspection 15t 2/20/25
Location and description
dates: 2 nd
m th
Bottom of siding
3`" 4
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
-= OFA \�l
Conditional Approval: Date
Septic System
Benjamin
125g2iller
Approved �' DateAW
1111 pROfESS1�N�+
N te: this approval does not include well permit require en
(Rev 05/02/1e
Benjamin Schiller
CE 12592
R
E
G
ISTEREDPROFE S S I O N A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP241333 PID # 017-101-21
ILIAMNA ACRES, TRACT 4B
A B
MH 41.6
SV 44.9
A B
2CO2 48.5
CO 1 68.7
MT 1 68.7
CO 2 81.7
35.6
47.2
49.2
75.6
75.8
80.2
FEET
0 50 100
PLAN AS-BUILT
3/3/25
GARAGE
3-B
D
R
M
H
O
M
E
10' UTILITY EASEMENT
10
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
10
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
RIVERTON AVENUE
EXISTING
ABSORPTION TRENCH
GREENHOUSE
NEW 1000-GAL
SEPTIC TANK
MT 1
CO1
CO3
LOT 5B
NEIGHBORING WELL
RADII OUT OF VIEWPORT
WELL w/ 100'
RADIUS
2CO1
2CO2
MT2
CO4
CO2
CO 3
MT 2
CO4
64.7
64.5
58.0
69.7
69.6
56.7
2CO1
42.2
42.1
PROFILE AS-BUILT
(NO SCALE)
91.9
87.6
92.6
96.6
MH
SV
1000 GAL
SEPTIC TANK
2C
O
91.7
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
3/3/25
2C
O
PERMIT # OSP241333 PID # 017-101-21
ILIAMNA ACRES, TRACT 4B
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: OSP241333
Work Type: SepticTank Upgrade
Tax Code Number: 01710121000
Site Legal Address: ILIAMNA ACRES TR 4B G:3037
Site Mailing Address: 5401 RIVERTON AVE, Anchorage
Owner: FREDERICK GARY A &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
10/22/2024
10/22/2025
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: �' Date:
Issued By: Date: C) Z Z/ ,zo
.i7
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. 017-101-21
Property owner(s) Gary Frederick & Diane Wink Day phone
Mailing address 5401 Riverton Ave, Anchorage, AK, 99516
Site address 5401 Riverton Ave, Anchorage, AK, 99516
Legal description (Sub'd., Block & Lot) Iliamna Acres, Tract 4B
Legal description (Township, Range & Section)
Lot Size 99,000 _Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
❑
Initial 1-1
Single Family (SF)
M
(w/wo ADU)
Septic Tank
EX-1
Upgrade RX
Duplex
❑
(D)
Holding Tank
R
Renewal R
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / 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:22
Date of Payment: L
Receipt Number:
Permit No. OC2,P2y1333
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_'-'- : - :-'.,'c -1
October 1, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Iliamna Acres, Tract 4B – 5401 Riverton Avenue
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home as well as the wells and septic location. No conflicts exist between this proposed
system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing
the septic tank with the same size designed for 3 bedrooms.
As part of this permit we are proposing finding and fixing the missing pipes in the septic field, to
allow for testing of the field. The new septic tank will be a minimum of 100’ from all wells and
surface water. Please refer to the attached plan for the septic design. If this design is followed,
there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241333, Curtis Townsend, 10/22/24
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
ILIAMNA ACRES, TRACT 4B
FEET
0 50 100
SEPTIC PLAN
10/21/24
GARAGE
3-BDR
M
HOM
E
10' UTILITY EASEMENT
10
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
10
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
RIVERTON AVENUE
EXISTING
ABSORPTION TRENCH
CAMERA SYSTEM AND
ADD NEW CLEANOUTS
GREENHOUSE
EXISTING TANK TO BE
DECOMMISSIONED PER CODE
NEW 1000-GAL
SEPTIC TANK
ADD 2COS BEFORE
AND AFTER THE TANK
MT CO
CO
LOT 5B
NEIGHBORING WELL
RADII OUT OF VIEWPORT
WELL w/ 100'
RADIUS
2CO
2CO
MT
CO
CO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241333, Curtis Townsend, 10/22/24
PLOT PLAN ___ AS BUILT _X_ SCALE _ 1_=_ 50=_ GRID _ SW 3037Project No. J24=209161
P.O. Box 210005 q�
Lang & Associates , inc. Anchorage, Alaska 99521-0005 l O 2p;>4
(907) 522-6476 o O F q 0�4
Professional Land Surveyors jonathanOlongsurvey.com �� • �� p4o
ken®langsurvey.co"o
m & A s�
I hereby certify that I have surveyed the following described property:
Tract 48, ILIAMNA ACRES SUBDIVISION (Plat No. 70-235)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said pro rty except as indicated hereon.
Dated this the '��� Day of __ CC' T�_," at Anchorage, Alask
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.
State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEAL. TH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/QR WELL INSPECTION REPORT
.
~d'GEW
[~UPGRADE
LEGAL DESCRIPTION
LOCATION ~'~/
Absorption area
NO. OF BEDROOMS
DISTANCE TO:Well
-- I ,'
Manufacturer ~ .~
[Liq. capa~it× in gallons I --- ,.
f¢'~ ¢/(~ I IF HOMEMADE:
IM~nufaeturer /-~ ~/'/9
--~--- I~ I WeU
~z /DISTANCE TO: I /
No, of lines J Lenmh of each line
Length Width /
~;f crib Crib diame~¢~
~ /'~/¢~
DISTANCE TO Building foundation
DwelJing ~j~// f
Inside length JW dt~
Dwelling
Foundation ~,~ ,
Total I on g~..9 f~i n.~s
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
JNearest JOt lin.~-.'~)
J Trench width
J inches
Z)L- OC~' II inches
PE~M,TN%:~/ma ~ /
No. of compartments
Liquid depth
PERMIT NO,
Liquid capacity in gallons
PERMIT NO.
Distance between li)),es
/"7
Total effective absorp, tion area
Total effective absorption area
Nearest lot line
Disf, m~ce ~o Io~ lin~ I~'RMIT NO,
kSept c tank J Absorption area(s)
OTHER
PIPE MATERIALS~
SOIL TEST RATING
INSTALLER
R EMAR KS
~,// ~ L..
jAPPROVED~
7~78)
DATE LEGAL
'TYPE OF :SE):[L RB:E;ORPT :[ ON :~;'~.':~"f'Ef'l ]:E;: TREI',ICH
I"IRX];I"IUI"1 NI...II"IE3ER OF BE[.'."ROOi"IS := 2.-': :SO]:l... F.'.RTZI'.~G ,::SE'::! FT,"BR::,=
THE REC;!U].'REE:, SIZE OF THE :.:.;OIL. RB:5ORPTtON 'E;'¢STEI"I
TNE L..EI'4(~,TH bIi'flEN2;IOl'.,l IE; THE LENGTH (IN F'EET) OF THE TRENC:H OR [:,F.:FIII",IFIEL[:,.
THE DEPTH OF' R TF,'.ENCH OR PIT IS THE DISTRNCE BETHEEN THE :E;URF'FICE OF:' THE:
GROI..IIqD RN[:, THE E~OTTOI"I OF'" THE EXC:R',,,'FIT'ION (IN FEET).
TI-.IEf;~:E Ir.'.:.; NO '::';ET .t4]:D]"H FrOR 'TRENE:HELS.
THE GRR',/EL DEPTH ZS THE i'"l.'[i'.,!]:i"lLli"l DEF'TH OF GRR',,,'EL BET!.,.IEEN ']'HE OUTFF:II..t... P]:F'E
FIHD TNE BOTTOP1 OF THE EXCFI',,,'RT]:ON ':::IN FEET:).
I='EI:~:PI!T AF'F'L]:CFINT HR2; THE RESPONSIBILITY TO INFOF..,P1 THIS [:,EPFIR, TP1ENT .r..',UR:[NEi TNE
INE;TFILL. FITION II'.,tSF'ECTIONE; OF' RN'-r' HELLS; R[)..TRCENT' TO TH:[E; PROPERTY FINE:, THE
NUI'"IBEF.: OF' REE;IDENCES THRT ]"HE HELL H~.I._L SERVE.
E:FIC:I.:::FILI_ING OF FINY 2;Y'::;TEM !-4ITHOLrT F'INFII_ INL=;F'EE:TION RND RPF'RO',,,'FIL E:Y
DEF.'RRTfqENT I.,.I :I: Lt. BE ."SUE.,'.~ECT TO PROSECUTION.
f,IINIi',IUM /DISTRiqE.'E BE'r!.4E'EN I:::1 HEL. L. laND RNY OI",I-SITE :SEP.IRGE DISPOSRL. S"r'S'TEP'I
±00 FEET F'OR R PR:[',,,'RTE [4ELL OR :'L50 TO 2e~e~ FEET F'F..'Oi"I R PUBLIC 1.4EL/.. r:,EPENF.:,ING
LIF'ON "rile TYPE OF' PUBLIC I.,~!EL.L.
PIlNIi',~Ui','i [::,ISTRNC:E FROI',I R PRIVRTE [4ELL.. TO la PF..'I'¢RT'E SEI4ER I_]:NE I~; 25 FEET F:II'.,ID
TO R COi',~i',IUNITY SE!.,.IER LINE ]:$ 75 FEET.
HEI_L. LOG:E; RRE F..'EE!U]:REE:, FiND I',IUST BE RETURNEE) TO THE [:,EF'RRTfdENT b.llTHIi'.,I :.4:0 E:,RY%
OF THE HELL COf,IF.'LETION.
OTHER REE!UIF..'Ei'.IENTS i'"lFl"r' FIPPLY. SPECIFICFI'rloN!; RND CONSTRUCTION I::,IRGRRi',I'E; RF.!E
I:'tVRIL. RBLE TO INSURE PR. OF'ER :[NSTRLL. RTION.
I CERT IF:".P THFI'r
:t.: i lam F'FIMILIRF.: I.,.IITFI TFIE REtT~LIIREMEI'.,IT"E; FOR ON-~E;ITE SEI.,.IERS FIND I.,.IELt..E; AS SE]"
F."ORTFI E:Y THE i',IUN I C :[ PR/~ I TY O[" RNCHOP::laGE.
· 2: ]: HII...L.. INL=;TFILL TNE S"r'E;TEI"I I1'4 RC:C:OR[:,FII'.~CE !AITN THE C:O.r..',E:?;.,.
2.-':: I UNDER:..'-;TFIN[:, THRT TNE: ON-SITE ?.,EI.,.IER ~S"r'STEI"I HRY REE!UIRE ENI...RRGEi"IEIqT
Fi:ELS :[ [:'ENC,~.%-.~S;,~.:Ei"IO[:,E~.ED TO :[ NCLUE:'E: i"IOF.:E THFIN .7.,:: BE:[:,ROOi'"IS;.
,,
1'HE
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE ,4IL SULLIVAN,
MA YO[4
DEPAR'T MENT OF ItEAL'FII Al,iD ENVIRONMEiNTAL PHOTEC FION
Decen~er 31, 1980
Ed Stevenson
3351 Amber Bay Loop
Anchorage, Alaska 99502
Permit ~ 800070
Subject: ]Lot B Tract 4 Illiamna Acres Subdivision
A permit issued by this department for well and/or sewer
system has expired as of this date.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for
our files.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
LNB/ljw
enc: Copy of Permit
SWP/057
PERMIT NO.
RPPLICFtNT Et:, STEVENSON 2~5:l. FIMBER BFIY LOOP
LOC:RT I ON
LEGAl_ LOT B TRRCT 4 ILLIFIMN8 8CRES.,"' LA]" ...,I,:.E
TYPE OF SOIl,... FIBSORPTION S'¢STEM IS: TRENCH
MFIXIMUM NUMBER OF BEDROOMS = 2 :SOIL RR"FING <SQ FT,.'BR)=
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
IPlLI~'--i I r_:: .,'[ F'RL..'[ "T-"¢ OF Fli'-.I C:H l':.~l~: R C-iE
DEPFIRTMEI'.,IT OF HEFILTH FIND ENVIRONMENTFIL PROTEOTION
825 "L" STR. EET., FINCHORFtGE., RI.-'..'. 99501
264-472'0
I..-IELL Flr-4t[:, ,.-J IN---"~. I 'TF_" '_~='; EI..JIER
,:: 8000?0 )
]:44-6625
±08900 SQURRE FEET
I[')EF'TH= 6 LEf-.II3T H = 51 [3 F-: R'..-' E L [:,EF'TH: ....
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE 'fRENCH OR DRFIINFIEL[:,.
THE DEF'TH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE
GROUND FIND THE BOTTOM OF THE EXCFIVFITION ,.'.tN FEET).
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFtVEL BETWEEN THE OIJTFFILI_ PIPE
RND THE BOTTOM OF THE ENCFtVRTION (IN FEET).
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRI..LRTIEIN INSPECTIONS OF RNY 1,4ELI,_S RDJRCENT TO THI% PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELl,. WILL '~]ERVE.
TI-.-IC, ,:'.' 2 ) I I'-.ISPEE:T I L--ill'-.l_'i~. RF-:'E F.:~]u];!LI I RE:[: .........
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION FIND FIPPROVRL BY THI:S
DEPRRTMENT HILl,.. BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWFIGE DISPOSRL SYSTEM IS
:1.00 FEET FOR FI PRIVRTE WELl,.. OR t50 TO 200 FEET FROM R PUBLIC.' WELL [:,EPENDING
UPON THE TYPE OF PUBLIC WELl,_.
MINIMUM DISTFINCE FROM FI PRIVRTE WELL TO FI PR I ',,,'RTE SEWER LINE IS ;-25 FEE'I' FIND
TO R COMMIJNIT~r' SEWER LINE IS 75 FEET.
WEt. L LOGS FIRE REQUIRED FIND MUST BE RETURNE[:, TO THE DEPFtRTME. NT HITHIN 20 DFtYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS MFt'¢ RPPLY. SPECIFICFITIONS FIND CONSTRUCTION [:,IFIGRFIMS FIRF
FP/RILRBLE TO INSURE PROPER INSTOL. LRTION.
I CERTIFY THRT
1: I FIM FFIMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FIS SET
FORTH BY THE MUNICIPFILIT"r' OF 8NCHORFIGE.
2: I WILL INSTFILL THE SYSTEM IN 8CCORDFINCE WITH THE CODES.
2: I UNDERSTFIND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCL.LIDE MORE THRN 2 BEDROOMS.
HPPLIbHNT~ ' '-Et, ~,TE~,EN ,~ IN
ACCOUNT ~
I1~ ~o.-~ I AJ~T. OF J J J'
J J ~ '~, ?.) '~ J ACCOUNT I I JCASH
J [ J' BA~E J('/! ' I ~ MONEY
~,~ DUE ' J -J I ORDER
HOW PAID ~..
_.~ ./.~~
eK608
', n~.r !,,¢:i' AtA. S!<A99501
December 31, 1979
Ed Stevenson
3351. Amber Bay Loop
Anchorage, Alaska 99502
Permit ~ 790059
Subject: Lot B Tract 4 Illiamna Acres Subdivis_ion
A pe~it issued by this department for well and/or sewer
system has expired.
PeA~its are issued on a calendar year basis, as stated on
the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer has inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our ~.].ea.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
LNB/Ijw
eric: Copy of Permit
DEPRRTr'IEr~
825 "L" STREET,,
264-4720
PERf'IIT NO. <
LOCflT I ON
T~'F'E OF SOIL FIE:SORBTICIN S,~r'STEM IS:
~. F'FtL I T'T' I[IF ~i'-. HI~_IF-"~I.~_iF~ ,,
OF HEALTH FIND EN\,'IRL-~NMENTaL PF,;OTECTION ,
aNCHORaGE ........Ri(. q':~UZ.-
_,": E ~,J E F.:
MR;:<Ii"IUM NUMBER: OF BEDROI_'IMS = ,~
LOT SIZE //O~dT~ S,;!LIRRE FEET
SOIL F.:ATING <SQ FT,~'E:F.:',= /~..~'-
THE REQUIRED SIZE OF THE iSL-IIL RBSL-IRF'TIC~N S'¢STEM IS:
[>EF"TH= ¢' /
I_E['-dl-iTH= ~-// -- · - , ,
, ~_~ -F-. ~t ... E [_ E:, i P' -F ~1 ~
THE LENGTH DIMENSION I~ THE LENGTH (IN FEET..') OF THE TRENC:H OP, r)F.:RINFIEED.
THE DEPTH OF Fi TRENCH 13R PIT IS THE DISTFiNi-:E BETHEEN THE SLF.'FRCE OF THE
GRFiI IND_ _ aND THE BOTTOM. 0F THE E,,,E.H~ RTI _ N"'- ' a ,"IN.. FEET's..
THERE IS NO SET WIDTH ~EIR TRENCHES. ·
THE GRFCv'EL DEPTH IS' TH.E MINIHIJM DEF'TH OF GRR',,'EL E:ETt,IEEN THE OLITFRLL PIPE
aND THE BOTTOM OF THE ,E,'.<iZRVRTION <IN FEET>.
F'ERMIT HFFLI_.MNT HaS THE R:ESF'ONSIE:ILiT,T, TO INFOF.:H THIS £:,EF'RRTMENT DI_R'ING THE
INSTaLLaTION INSPECTIONS 0F aNN' HELLS R[:,JRC:Et-~T TO THIS F'ROPEF.:T'¢ aND THE
I.d_It'IE:ER OF RESIDENCES THaT THE WELL WILL SERVE.
T L.JmZ:l ':: 2 .':, I ~-4$F'Em_-~-T I BZmF-dLS FIRE Fd: E L.~!I_I I F;EC,
E~RC:KFILL ING OF aNN' S'¢STEH' 14I THOUT FINAL INSPEC:TION aND RPPR'C',/RL B'-r' THIS
[)EPRRTMENT NILI~ ' BE SLIBJECT Ti-i PF.:OSECUTION.
MINIMUM DISTFIt-IC:E BETNEEN R NELL aND aNN' CtN-SITE SEWAGE [:,ISF'OSRL SN'STEM
iO0 FEET FOR FI F'RIVRTE WEEL.~ Ca'
~50 TCI 200 FEET FROM R PUE:LIC NELL DEF'ENDING LIF'ON THE TN'F'E OF F'UE:LIIZ: NELL
HELL LOGS RRE REQUIRED aND MI_IST E:E RETURNED TCI TIdE [:,EPRRTHENT WITHIN
OF THE NELL C:C~MF'LETION.
OTHER REQUIREMENTS f,lR'¢ RF'F'L~'. SF'EC:IFICRTIONS aND cor.dSTRL,i:TION DIaGRaMS RR:E
R',,,'RILRBLE TO INSURE '"- '"
FRUFER INSTaLLaTION.
I C:EF.:T I F',r' THaT
1: I aM FRHILIFIR WITH THE REIZUIRErdENTS FOR ON-SITE SEI,IERS aND WELLS RS SET
FORTH B'.r' THE MUNICIF'FtLIT'¢ OF aNCHORaGE.
2: I WILL INSTALL THE S'¢STEM IN RC:C:CIRDRt.41_-:E WITH THE CODES. .
Z<: I LINDEF.:STFit.,I[) THaT THE Cit.~-'--;ITE SEI.,IEI;: S'¢S'I'EM MaY REi..-.P_IIRE ENLRF.:GEi',IENT IF THE
RE%I[:,ENCE IS REMODELED Ti3 ,INCLI. IDE I"lnF.:E THaN 0 E:EDRi-OI~IS.
Applicant
r::IF:'PL I C F:Ii",IT
LOCFIT I ON
ED S TI~i:'v'EI'.,IS;ON
LOT
~:]1:5:?. F:IHE:EI~.'. E:FI"r' LOOP
T"r'PE OF SO :1: [... I::~E~'.:~:';I]F~:E:'F I OIq ~S"r':.:'2'FEH I :!]~: TREIqC:H
f"lFl::.:::[l'"lt.r.ll'"l I'qt..li"l[!=[i;f(: OF E~E[)F;?,OOM:L:; =
RED :L:; I ;;.~]:i,': Of THE :!i;O :[ L,. I:::ll:!i:'.?:;Ol~F'T I ON S'?'S:;'T'EM 1 5;:
"['HE L. ENG]"H [:,IM[.:.I",IS";II::)N IFF..:; ]';"IE: I...EN(.:iTH ,::II'.,l F[~[i::T::, OF Tt..lli~ ...........t[ [:b! !1 OR [:,RF:I:fI",tF::'IF:i:I.r.D..
]'HE I}EF::'TH Of F:I TRENCH OF~:'. P:I.'T :I::S TH[ii: I".:,I:STI::IIqCE [:}ETI.,.!EEI'.~I THE '.":i;UF~'.F:Fp:'::E OF' 'rf'HE
GROt..IN[:, I::11'.,1[:, THE Bo]r']"Oi'"l OF THE: E~:',:':',CFI"/FtTIOI'"I ':: :1:1'"1
THEF:~:E I :"5 IqO SE]" P'I:[ DTFI FOF?. TRISNC:HE!S.
THE!: I]i['.l'~l, [:]... [)EF:'TH I :E; 'I-'HE I"t ]: i'"t I ML.IH DEI:::'TH OF 51:]i': V[::':L Blii:TI.'.IL::EN THE OIJ"I'FF:ILL F"'
FINI:) 'T'HE E:OTTOH (]iF THE I:}!:::'::CFI',,,'FIT l' O1",1 ( I I".! f:'EET ).
F::'E:F~:MI'F F:IPF:'L. ICI:IIqT I"11::1':'~; ]'HE Rli'~:S;F:'ON~i;IE:II..:[T"r' "FO II'.,tF:'ORM TI*I]:~:.; [:,[:~:F:'F:IR]"MEI'.,Ff' [::,l. JRl'Ni]i THE
]:N:STF:IL.I..I::ITION ):I'.,I5;F::'[~C't":[ON:i!~; OF::' F:ff.,l'.r' I.,.l[iJLL...:i!!: i:::l[:,Jl:aCl-~]qT TO TFII~i; F:'ROI:::'!:':(F~'.'T".r' F:ff',l[:, TH[ii:
I",ILIHE:ER OF:' R[.::'.:2;I[:,EI'.,IC:E'.~; THF:I'F '['I"IE I.'.IEL. I.. HILl_..
E:[::tI:]I<]:::' I Lt.. I NG OF::' Ftl",l'.d '.S"r'~;TEH I.,-!]: THI.']IJT F' I NFIL I i",I:SF'EC T ]: Cd",l FII",ID F:IF::'F::'RO'v'F:II... 1:3"r' 'T'H Z !ii;
t]'EF::'FIF;?.THENT I.'.11 t...L 8E :SLIEk:fEC]' TO F'RO!SECLIT ]: ON.
I'"11 N I HLIH I:::' I 5;'['FINC[:~ [:ii:ET!-,.IEEN F:I I.,.t[EL.L Rf',l[) FIN"r' ON-:E; I 'T'[i:: 5;EHFIGI:~: [:' I 5;F::'OSFII... S"r':E;"I"E:H :t::ii:;
:I..0!:.~!1 f::'[~:':[!!:]' F::'CIF..' FI F:'F.'.I',/I:::I'i"[i!: I.,.IEI....L..; I.][F~'.
J..~:.~O "t'O ;:i~I~iEI FEET f:'I:,?OH I::1 F'UEg.. I C I.'.IELL. DEPEN[:' I NG UF:'OI",I 'T'HE T"r'F::'E OF:' I':'LI:E','L. ): C I.,.l[ii:l.J
HELL. LOGS; I::IF.:E F?.EL:.!UZREI:)I::llq[) iVly"E;]~ Eli.:: K::[F:TLIi:E'.N[~:[:, TO THE!: [:'[~:PFIF,?."I'HEI",IT HITHIN ]:O E:'l::l"r'!:~;
OF:: THE: I.,.IELL COHPI...ET'[ON.
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I:::l'v'f:l t L.F:IE~I....E ]"O I I'-,ISUI-;i:E I::'ROF'I:ZFE'. I I",I."S'I"f::ILLFI]" I ON.
t CEF::T I F"r' 'I"PIFFT'
::L: I I:::IH FI::IM:[L.T. F II~'. ,L,.II]"H THE [;i'.[~:~.~:!t..l:[l:~:[:~:i'"l[:!:l'.,l'['~:~; F:'OR (:)N.-..~':;ITI!: :~:[ii:l,.IEi:F[:~i:; FIND I.,.IELL.S; I:::1~:~;
F::'OF;i:TH [3"? THE MUI'.,I I C :[ PI::IL I ~1"~' OF: F:INC:HORF'IGE.
2: ]: t.,.1:t: 1...t~ t I",I:!.Ff'FILL 'T'HE ~i;'t'..:~TEM I I'.,t F:ICCOR[:,RNCfi:: H :!: ]"H THE. CO[:,F?S.
::!!:: Z IJf,.I[.',ERS]"FIN[:, THF:IT THE CIN-S:I:'I"F.~: ::ii;li~l.,.IE[~: '::Ji't'~;TEM MI:::I'T' RI:'.~:(~:!U]:F;i~[!i: I:~NL.I:::IRGli~:HENT :1:1::' THE
RF:i:SZl}ENC:E Z~ fi?.EMODELED TCI II",ICI...IJ[)E i'"IOI"~:E THFIN 2:::
S I Ciil'.,IE [:,: ..........................................................................................................................................................
FIF:'F'L.. I Cf:INT El::, S"I"Ii:;:VI~::I'.,ISON
· TESTING · EXPLORATION · CHEMICAL · t4ATERIALE, · INSPECTION
4040 "B" Stree~
Anchorage, Alaska
99503
October 29, 1974
W.0. #17111
279- 2581
Mr. Gary Lewis
Star Route A - Box 330 T
Anchorage, Alaska 99507'
SUBJECT: Seepage Pit Analysis
LOCATION: Lot B, Tract 4, Illiamna Acres
Dear Mr. Lewis:
On October 28, 1974, Larry Johnson, senior technician, of our staff, logged
a test pit in the vicinity of the proposed seepage pit, located per the
attached sketch. Ail soils encountered were visually classified in the
field in accordance with the criteria contained on Sheets 1 through 3 fol-
lowing the text. The samples from 8.0', 9.0'-10.0', 10.0'-12.0' and IS.O'
were brought into the laboratory for additional visual 'review and class-
ification based on the same criteria. The composite of the field and lab-
oratory review is compiled in the following test pit log.
Test Pit 1
'-Depth in Feet
From To
0.0' 1.0'
1~0' 1.S'
1.5' 6.0'
6.0' 9.0'
9.0t
1S.O'
Soil Description
F-4, tan, sandy silt, damp, hard, PLy ML, large cobbles
at transition
F-2, brown, silty gravelly sand, damp, high density, SM
NFS, brown, sa.ndy gravel with layers of F-2 silty
rav~~ s.and,'(30%± of the strata), damp, h'igh density,
rounded particles, 6"-, GP-GW/SM
NFS/F-2, grey, silty gravelly sand with occasional
cobbles, damp, high density, SM
F-2, grey, silty gravelly sand with occasional cobbles,
damp, high density, SM, with random layers of sandy'silt
and with pockets of NFS sand to sandy gravel
Mr. Gary Lewis
Page 2
October 29, 1974
Test Pit 1 (continued)
Bottom of Test Pit:
Frost Line:
Free Water Level:
Sample Depth
1 8.0'
2 9.0'-10.0'
5 10.0'-12.0'
4 10.0'-12.0'
5 15.0'
15.0'
None Observed
None Observed
Type of
Sample
G
G
G
G
G
Renmrks: 1.
2.
3.
Test pit located per attached sketch
Elevation: Existing Ground
Date of Exploration: October 28, 1974
4. Type of Sample, G = Grab
The seepage area required per bedroom by soil type (per the Greater Anchorage
Area Borough) is as follows:
Soil Type (Unified Classification)
ML
SM
SP
SW
GM
GW
~eepage Area Required
275 ft.2/bedroom
250 ft.2/bedroom
1S0 ft.2/bedroom
125 ft.2/bedroom
225 ft.2/bedroom
85 ft.2/bedroom
Soils requiring greater than 250 ft,2/bedroom are not allowed in seepage pit
Mr. Gary Lewis
Page 3
October 29, 1974
area calculations (per the Greater Anchorage Area Borough).
The seepage area required at depth can be expressed as follows:
Unified Soils
Depth Classification
0.0'-1.0' ML
1.0'-1.5' SM
1:5'-6.O' GP-GW
6.0'-9.0' SM
9.0'-15.0' SM
Seepage Area
~equired
275
250
134.5
250
2S0
~nclosed are some excerpts from State and Borough ordinances which may be
of value to you. For further restrictions, particularly with reference to
location of the seepage pit, we call your attention to the Greater Anchorage
Area Borough Ordinance 28-68.
Please call if we can be of further service.
Very truly yours,
ALASKA TESTLAB
John M. Lambe
JML/vms
¢~nclosures
CHUGIAK, ALASKA
688-3199
'A VJIL&14
NvIll;RILLING CO!S
WE SERVE ALL ALASKA
POST OFFICE BOX 42 - CHUGIAK, ALASKA 99567
KODIAK, ALASKA
486-4826
I \ �Llc_ v �-A
OWNER OF LAND .... I . ...... ............... ......... DEPTH OF WELL ........... ��.
........... I .......................... ..... I ...................................................................
ADDRESS............ ................... ....... ................................... ............................. STATIC LEVEL OF WATER FT . ...... ......... ........... .............. ; ..........
WELL — SITE .—"'—...'.'
........... DRAW DOWN FT..-._....
...............................................................................
DATE — STARTED ..........
.......... GALS. PER HR.. .......:..:.... }...............................................................
DATE —ENDED ............
.... ........................................................................... KIND OF CASING ....... ................. ...............................................................
KIND OF FORMATION:
FROM......................
FT. TO
..............
FT . ................................
FRO M
..............
FT. TO
.......... ........FT.
.............. .......
FROM
.... .........
FT. TO
.......................
FT............. .............
FROM......................
FT. TO
......................
Pf
FT....................................
FROM
..... ................
FT. TO
......................
FT....... .............. . 1.
FROM
......... .............
FT. TO..-
..............
FT....... .
FROM....
....... ........
FT. TO
...................
FT......... .......................
FROM
......................
FT. TO
.................
FT......: ... ...........
FROM......................
FT. TO
......................
FT . ...................................
FROM......................
FT. TO
......................
FT . ...................................
FROM......................
FT. TO
......................
FT . ...................................
FROM......................
17. TO
......................
FT . ...................................
FROM....................... FT. TO ....................... FT . .................................
FROM....................... FT. TO ........................ FT . ................................
FROM....................... FT. TO ........................ FT . ................................
FROM....................... FT. TO ........................ FT . ................................
FROM....................... FT. TO ........................ FT . ................................
FROM....................... FT. TO ........................ FT . ................................
'jiZ,
FROM....................... . . . ................................
FROM....................... FT. '.2.; ...................... FT . ................................
A Id
-i " FROM ....................... FT. TO T . ................................
FROM ....................... FT. T Q I . ..,3
FROM....................... FT. TO ....................... FT . .................................
FROM....................... FT. TO ........................ FT . ................................
MISCL. INFORMATION: /—.-f S 16-466 v to' cr cor
7 2 / c a /c5:3,6- z NeAw' ZpFcT 34.1. 7-12 3 vte-s�
17 //
Cc-,
DRILLER'S NAME ............................................... ; .....................................................................
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251067
Parcel ID 017 -101-21
Legal description ILIAMNA ACRES TR 413
Site address 5401 RIVERTON AVE
Expiration Date: 2/26/2026
Current property owner(s) FREDERICK GARY A &
X The On-site system(s) is/are approved for 3 bedrooms
By:
This s rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sy tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
evelopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
Development Services Department . . Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-101-21
Complete legal description lliamna Acres TRgc- fi 9/3
Location (site address) 5401 Riverton Ave, Anchorage, AK 99504
Current property owner(s) Gary Frederick & Diane Fink Day phone (907) 227-4029
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑■
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 8
Date of Payment�-
COSA #
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to:(Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Tank to Property Line > 5’Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date Benjamin Schiller, P.E.
DATE OF SURVEY: 25 FEBRUARY 2025
PLOT PLAN —__ AS BUILT _X_ SCALE _ 1_ 50__ GRID SW 3037 Project No J24-209162
0005
Lang & Associates, inc,.O. Anchorage,
Alas �� S
• Anchora e, Alaska 99521-0005 �E O � �-�
(Professional Land Surveyors `907JyCa64srve com OF q
surve g y.
I hereby certify that I have surveyed the following described property:
Tract 48, ILIAMNA ACRES SUBDIVISION (Plat No. 70-235)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the of
_ , at Anchorage, Alaska
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.
ONAT C. LANG
0
LS -9944.• ' SJpG
O
ROFESSIONA\- �pQo
0400000
State of Alaska AECC963
DEPARTMENT OF HEALTH& HUMAN sERViCES::' t~ll
- Division of EnVironmental services.: ' ~
On-Site Services Section ' . ~
P.O. Box 196650 Anchorage, Alaska 99519-6650
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I,D.# ~\-~- IC')\-~/ HAA# ~-'~O~?k~)~.~(,~
1.' GENERAL INFORMATION
Complete legal description Illia~na Acres, Tract 4B
Location.' '(§i{~'ad;dress or directions)
,~. "Prope~'owner.. D~n~is Mendel
5401 Riverton Rd., Anchorage,
Day phone
AK 99516
.,~.. J,,Mailing address
'.:. Lend ng agency
address
. . .. -'?.~... L,..~-,
- Agent r~., ~, ~,, ~
Day phone
"Day phone
2. '~'~NUMBER OF BEDROOMS:_·
4. TYPE OF WASTEWAT~D~SPOSAL: ..... ~k-..
. , .-, ,' ,. Indw;dual:~a-s~te · . ' ~:~"
. ', ,.~ ~ uommu~i~y on-site - . '
NOT~: If com~uni~ Wastewater system, provide wri~en confirmation from State ADEC
a~esting to the legali~ and status of system. "': ' -
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 vedfy 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 Environmental Management, Inc. .~ Phone (907)272-9336
Address _206 E. Fireweed L,.n.~', ~. choral, AK ~03
~ John Ear} Simpson
DHHS SIGNATURE ~/ ,~,~ F~OFES$\~," ~
Approved for 7 bedrooms. "'
Disapproved.
Conditional approval for bedrooms, with the followir;g stipulations:
,,,'.,Additibnal (~0mments
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 p?ofessiona! engineer's work.
72-025(Rev. 1/91) Back MOA~I
Municipality of Anchorage ,~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Illiamna Ac:~es, Tract 4B Parcel I.D.
A. Well Data
Well type Private
Log present (Y/N)
Total depth 95 ft. Cased to
Sanitary seal (Y/N) Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 10-31-80 Driller Jay Wi].li~-~ms
84 ft. Casing height 28 in.
FROM WELL LOG
Date of test 10-31-80
Static water level 20 ft.
Well flow 5
Pump level1 84 ft.
SEPARATION DISTANCES FROM WELL TO:
102 ft.
113 ft.
N/A
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
Wires properly protected (Y/N) ~'
AT INSPECTION
4-3-95
21.75 ft.
g.p.m. 1.5
84 ft.
; On adjacent lots
; On adjacent lots
g.p.m. ~o~,
150+ ft. ~
150+ ft.
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml
Date of sample: ,~/14/95
Nitrate
1.43 mg/1 Other bacteria O cnlon~,~./lnn ml__
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed · 7-~ 1 Tank size 1000 gal
Cleanouts (y/N) .. y
High water alarm (Y~N),
Dateof pumping ..... 4-5-95 - , ~, Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Compartments 2
Foundation cleanout (Y/N) y Depression (Y/N) N
' N Alarm tested (Y/N)
Isaacs Pum~inq Service
Well(s) on lot 102 ft. On adjacent lots
To property line 50+ ft. Absorption field
Sudace water/drainage Non~ nhm~_rv~d
150+ ft. Foundation 31 ft.
8 ft. Water main/service line 20+ ft.
72-026 (3/93)' Front CONTIN U ED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed 7/81
Length 57 ft. Width
Total absorption area 770 sq; ft, Cleanout present (Y/N)
Sudace water
Date of adequacy test 4-3-95
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) 135 sq ft/b~ System type
Gravel thickness ~Total depth
y Depression over field (Y/N)
Results (pass/fail) Pass for 3
74.8 inches Aftertest 79.2 inches
N If yes, give date
On adjacent lots 150+ ft. Property line
To existing or abandoned system on lot
Cutbank N/A Water main/service line
t¥~n~h
9.08
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 113 ft.
To building foundation 41 ft.
On adjacent lots 120+ ft.
Driveway, parking/vehicle storage area
Surface water none observed
Curtain drain N/A
E. ENGINEER'S CERTIFICATION
2N+ ff
20+ f'h.
~n.t- f~__
Waiver Fee $
Date of Payment
Receipt Number
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back
I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in eff_~e date of this inspection.
/ ....
{/ / // £4;"'
. .~-- _~ {,.~ ..
~ /~NGF[SS~~ ~
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Illiamna Acres, Tract 4B
Parcel I.D.
A. Well Data
Private
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 10-31-80 Driller Jay Williams
Cased to 84 ft. Casing height 28 in.
Y Wires properly protected (Y/N) Y
Well type
Log present (Y/N)
Total depth 85 ft.
Sanitary seal (Y/N)
FROM WELL LOG
10-31-80
Date of test
Static water level 20 ft.
Welt flow 5
Pump level1 84 ft.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
102 ft.
113 ft.
N/A
N/A
AT INSPECTION
4-3-95
21.75 ft.
g.p.m. 1.5 g.p.m. ~
84 ft.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
150+ ft.
150+ ft.
N/A
m
z
Petroleum tank N/A
WATER SAMPLE RESULTS:
Coliform 0 Colo,;~s ~oo~,,.,4
Date of sample: 8/14/95
Nitrate
/. ¥3 m~ / .( Other bacteria
Collected by: ~
B. SEPTIC/HOLDING TANK DATA
Date installed , 7.-81 '. Tank size 1000 cfa]_
Cleanouts (YIN) '¥ Foundation cleanout (Y/N) ¥
High wateialarm (~;/N). . "' .N · Alarm tested (Y/N)
Compartments 2
Depression (Y/N)
Date of pumping ' ' ~'- 5-- ~- Pumper
SEPARATION DISTANCES FROM SEpTIC/HOLDING TANK TO:
Well(s) on lot 102 £t. On adjacent lots
To property line 50+ Ft. Absorption field
Surface water/drainage None observed
150+ ft. Foundation 31 ft.
8 ft. Water main/service line 20+ ft.
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C, LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Date installed
Length 57 ft.
Total absorption area
Date of adequacy test
Well on lot
D. ABSORPTION FIELD DATA
7-81
Width 2
770 sq ft.
4-3-95
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Soil rating (GPD/Ft2) 12,5
ft. Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
86 inches
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 113 Et. On adjacent lots
To building foundation 41 ft.
On adjacent lots 120+ ft.
Y
Pass
System type trench
6.75 ft. Total depth 9,0R
Depression over field (Y/N) N
for .3 Bedrooms
After test 90.4 inches
If yes, give date
150+ ft. Propertyline 2~+ ft.
Surface water none observed
Curtain drain N/A
E. ENGINEER'S CERTIFICATION
To existing or abandoned system on lot N/A
Cutbank N/A Water main/service line
Driveway, parking/vehicle storage area 50+ ft.
20+ ft.
I certify that I have checked, verified, or conformed to all MOA and HAA guidefines
/,"1 /
Signature /~'///~" l- ~///
Engineer sName~X]~/~/~%~__~ ~>~ /~/
Date
HAA Fee $ ~"¢2' ~
Date of Payment
Receipt Number /~;'~/..~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
¢~::~.,,'1R.,"~ t 0: 23 E:OHHEF.!C I RL TEST I HG
CT&B Ref.~
Matrix
CT&E Environmental Services lnc,
Laboratory Division
Laboratory Analysis Report
WA'rER
Client Salnple ID OUTSIDE FAUCET ILIAMNA ACRES L4E
Clien~ Name ENVIRONMENTAL MGMT INC (EMI) WORK Order 17149
Ordered ~y I~ARRY Printed Date 08/17/95 ~ 13:20 hrs.
Project Na%ue Coll~¢tsd Dabs 08/14/9~ ~ 12:00 hrs.
ProJact~ Recsived Date 08/14/95 · 12:25 hrs.
PWSID UA
Technical Director ST~PH~N C, EDE
Sample Re~aark~: 8~MPLE COLLECTED BY: M.M.I.
QC Allowable EX~. Anal
Parameter Results Qual Units Meghod Llmit~ Da~e Date Init
Nl~rate-N 1.43 mg/L EPA 35~.2 10. 08/16/95 DJM
See Special Inetru~Cions Above UA - Unavailable
Sea Sample Remarks Above NA - Not Analyzed
undetected, Reported value is th~ practical quan~l£ica~ion limit. LT - b~o~ Than
Seeo~%dary dil~lon. GT - Grsater Than
200 W, ~0[~ef Ddv~, Amoh0taOs, AK 99518-1 605 --Ish (907) 552-2343 ~8x~ (907) 5~1-5301
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
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
Parcell. D.# .~Et--] ~ ~(~\- ,---O.\ HAA# ¥-~ ~"~(7'lZ~Ch~(¢)"]
1, GENERAL INFORMATION
Complete legal description TZiamna Acres Subd±v±s±on Lot 4B
Location (site address or directions) 5401 Riverton Avenue
Property owner
Mailing address
Ed Stevenson
5401Riverton A~nue,
Day phone 345-0684
Anchorage, AK 99516
Lending agency
Mailing address
Day phone
Agent
Address
Phyllis Hackett Dayphone 279-2001
2600 Denali St., Suite 400, Anchorage, AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 ~
TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State AD£C
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the 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 d/~te of this ~nspecbo .
/I
NameofFirm Env±~or~ental Hanag/e~ent, Tnc. Phone 272-9336
206 E. Fi~/eweed~Lane, /J~201, Anchorage, AK 99~
Address !,! / ( '//"
DHHS SIGNATURE
_7~ Approved for ....5
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
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,
72-025 (Rev. 1/91) Back MOA ~Y21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Iliamna Acres Lot 4B
A. Well Data
Parcel I.D.
Well type Private
Log present (Y/N) Yes
Total depth 8'5 :, Feet
Sanitary seal (Y/N) Yes
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 1982 Driller Jay Williams
Cased to 84 Feet Casing height 28' '
Wires properly protected (Y/N) Yes
g.p.m.
FROM WELL LOG
Date of test 10- 31 - 80
Static water level 20'
Well flow 5
Pump level1 84 '
From MOA' records
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 102 Feet
Absorption field on lot 113 Feet
Public sewer main N/A
Sewer service line N/A
AT INSPECTION
05-18-94
19 Feet
5
84'
; On adjacent lots 150 Feet +
;On adjacent lots 150 Feet +
Public sewer manhole/cleanout
Petroleum tank N/A
N/A
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 05 / 18 / 94
B. SEPTIC/HOLDING TANK DATA
Date installed 08 / 82
Nitrate
Tank size
1.29 rog/1 Other bacteria
Collected by: Chad Helgeson
1000 Compartments 2
Cleanouts (Y/N) Yes Foundation cleanout (Y/N)
High water alarm (Y/N) No
Date'~of pumping 05 / 13 / 94
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot · 102 Feet On adjacent lots
To property line 50 Feet + Absorption field
Sudace water/drainage None Cbs erved
Yes Depression (Y/N)
Alarm tested (Y/N) N/A
McDo~aldS
No
150,:.Eeet. + Foundation 31 Feet
8 ~;. Water main/service line N/A
72-026 (3/93)' Fron~ CONTINUED ON BACK PAGE
C. LIFT STATION N/A
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed July 1981
Length 57 Feet
Total absorption area
Date of adequacy test
Soil rating (GPD/FF) 13 5
Width 2 Feet Gravel thickness
770 sq. ftCleanoutpresent(Y/N) Yes
05/18/94 Results (pass/fail) Pass
System type Trench
6.75 focTt°taldepth 9.08 Feet
Depression over field (Y/N) No
for 3 Bedrooms
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
91''below G.L.Aftertest 28''below G.L..
No If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot 113 Feet On adjacent lots 150 Feet + Propertyline 100 Feet
To building foundation 41 Feet To existing or abandoned system on lot N/A
On adjacent lots 100 Feet + Cutbank N/A Water main/service line N/A
Surface water None Observed Driveway, parking/vehicle storage area 50 Feet +
Curtain drain None Observed
E. ENGINEER'S CERTIFICATION
.. I have checked, verified or c~¢rmed to all MOA and HAA guidelines ,n effe~.~l~/~.~Cf~ ~. ,nspection.
I ceN~ ~at , , ~. ~ ~ ........ ' '~
/ u / // :..:"
HAA Fee ~ ~"'~---F~'
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number.
72-026 (3/93)' Back
F~N\"IRONMENT,-kL
MANAGEMENT
INCOR?OR:\TED
May 25,1994
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Well and Septic Adequacy Test for Lot 4B, Iliamna Acres Subdivision
Our inspection and test of the system located at the above location indicated that it is
functioning adequately to meet its intended use. However, it appears the system was
installed without a foundation cleanout. A foundation clean out has since been
installed inside the orawlspace within the foundation.
? Sincerely,
Envi.r.~,n m ental,.M an age/m~nt
, /' I , ~; I /
· ;//2 /?
.,' /John Simpson PE~,/
/~/ Civil Engineer
There is nothing to indicate any change in the system since it was installed. It appears
to have been functioning well since that time. For passing the standards for a 3-
bedroom house the system is safe, functional, and adequate for this 3-bedroom
house. Therefore I recommend approval of the system.
206 E. FIREWEED LANE, SUITE 201 · ,'\NCHORAGE, ,AK 99503-2703
C'ONSUUFING (9(17) 272-9336 · FAX (907) 272-4159 · TRAINING (907) 272-8852 ° FAX (907) 272-0319
NO. 846,
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~"~J~f~e'~'~'~r~-fj~-~.~.~.~f~~j~~
LABORATORY ANALYSIS REPORT
94.2379.}
OI.YI;'qII)H I"A U C I,.'T
\'VA'I'RIt
EN V[R ONMENTAL MGblT l~c ('EMI)
8TAN DOLLOFF '
UA
WORK Ordur 78592
Prin(cd D~dc 05/22/94 (~! h5 4'9 trs.
Collccled D,,~ie (}5118/94 '/.j~ 4:q0 ~.
Received Dal~ o5/18/94 (~ 15:35
'l~chnical F~rector S'['EPIJ~N C. b',l)F;
Released By: · '~7%d.,__ ~
~---~;~ SAM~I E COLL,.15CTb;D BY: C'HAD it-IE~GESON ANt') WFI'N E.".i,'-;I.',D B~' F.'D
STEVENSON.
Qc
-_ Allmv~l)le
Results Omll I lJts Mcthod b its
1.29 ~ g/L EPA 353.2/300,8 l(}
Ext. Anal
Dale D,'uc Init
05/ 91o4 MCI.;
s(JrlU;l'(° H'°' Ab° v c Ilfi~. Unuv
~atl, sAl>ovc , - = . ' ailablc ......
udcd value is thc pract.icnl qtm]tilicaiio~t I nit. ; ~.3' ' ~ NA = Nol Aaalyzcd
oil iT= r~ss ~an
5~33 g Slreot, Anchorage, AK 89518-1800 ~ TBJ: ~g07) 582-2343 FSX: (g07) ~81-S301
[TAL fACILITIeS IN ~SKA COkOflAOO. ~LORIDA, /LLINOIS. MABYLANO. N~W 3EBSEy. OHIo, UTAH, W~ST VIgGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTFIORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1, GE~'~ER^L It'!FOF{MA'I'ION
(a) L.egrd./~¢.TDescription.../.Z.¢_ (include. ?.~">~--?---~- ~ ~' _'%-<'l°t' block, subdivision,~ .~secti°n' township,./~//-¢/N~range)
Location (address or dil'~ens~
.......
Applicant Address ~'~¢/ ~~¢~ ~¢~
(c) Applicant is (check one): Lending Institution []; Owner/builder/~ Buyer []; Other [] (explain);
(d) Lending Institution 4'/¢c',~ gJ"~ f'~ Telephone
Address
(e) Real Estate Company and Agent _ /~//'JF
Address
Telephone
(f)
Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family~['~ Multi-Family []
Number o[ 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.
SEWAGE i.}ISPOSAL
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.
Page 1 of 2 72-025 (11/84)
ENGII'IEER]IqG FIRM PROVIDING INSPECTION'S, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein, 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 t~sI~.>ction, t
Name of Firm ~.~' .~,,-~'¢=- .~'~.2,/~ ~-~ ,/'~'~¢~':::;_ ~.~.~Telephone . ,"~4//~' .--~¢'(<~_.5t/
Date ____ -~ --/~' - ':¢'~
Approved for~'~'?~'-~ bedrooms by/~~44' ~'¢~,,~,~__ Date
Approved ~ Disapprov6~l Condi io~r¢l.
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-o75 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification
MUNiCIPALiTY gl'
DEPT. OF HEALTH &
ENVIRONNtENTAL PRoI'ECTION
1986
Well Log Presen / )
Total Depth ~9 ' Cased to
Static Water Level ~ /
Casing Height Above Ground
Electrical Wiring in Conduit~N)
If A, B, C, D.E.C. Approved (Y/N)
Date Completed . ,/2~ ' ~/~ ~'~--~ Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casin~)
Depression Around Wellhead ('~'~.
Separation Distances from Well:
/
To Septic/Holding Tank on Lot _/'~? · ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~'¢ <TL ; On Adjoining Lots
To Nearest Public Sewer Line -~ To Nearest Public Sewer
Cleanout/Manhole ,--¢"'/,-~/~,/. ,_~To/ Nearest Sewer Service Line on
Water Sample Collected by ./([/~"/-' '/ ,¢/~r ~,~-¢-"~-" ; Date , _~"~
Water Sample Test Results -~-~/'¢¢7~'~/'1
(..~-,
Co m m e nts ~ ~ _/-/_- ~'
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipe ~F~'~) Air-tight Caps~J)
Depression over Tank (Y~)-}
Pumping/Maintenance Contract on File (Y/N) .
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size ,/~'~>¢~¢ No. of Compartments
Foundation Cleanout (Y~
_..,.Bate Last Pumped ~ '-
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Water-Supply Well ,/'~¢'¢~ / //"'
To Property Line ~ '~'/-~ / , To Disposal Field '...~'~;¢ /~'''~-~
To Water Main/Service Line . ~ To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
~ . //
Width of Field - ~-~'
Type of System Design
Length of Field
Depth of Field ~d"7
Gravel Bed Thickness
Standpipes Present)
Date of Last Adequacy Test
/
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 .-4/~/~,¢~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
/
To Property Line ~:¢~ ~--'
To Existing or Abandoned System on
; On Adjoining Lots ,,'"~-'¢~
/.
To Cutbank (if present)
To Driveway, Parking Area, or Vehicle Storage Area ~-':*¢ '/'¢-~
Comments ~.~,z~ ~ ~-~-"r~%'C',CC~r~' ? ~'~ .~/?'~- .:-~-¢-'~¢¢/'¢ ~"~- ~/~"¢~'~'¢7"~
LIFT STATION ,~'
Date Installed Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
High Water Alarm Level at
Tested for
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I h~ve checl~d, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
BESSE, EPPS & P(~i'£S
2220 EAST 88 AVENUE
ANCHO~A~, AK 99507
(907) 349-6451
W~ ~LT~
Date:
Subdivision:
Lot:
Block:
Client's Na~e:
Address: O~4~ /
Initial Reading on Meter:
MUNICIPALITY OF ANCHORAG~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MAR 2 i t986
RECEiVI:D
Production Rate: ¢.'~ GPM 24-Hour Capacity ,...X?.,.~O Gallons
