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Home My WebLink AboutKNIK HEIGHTS BLK H LT 3Knl,bk Heights Block H Lot 3 #017-372-03 QQL v I Municipality of Anchorage Community Development Department 'SEPP14 [uig 3 On -Site Water & Wastewater Program R y 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141129 PID Number: 017-372-03 ❑ New ®Upgrade Nome: CAMERON & MARLYS GILCHRIST ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: 12900 BAINBRIDGE ROAD *ANCHORAGE, AK ❑ Other Phone: (907) 360-9414 No. of Bedrooms: 5 Soil Rating: 0.45 cpD/sa. n. Total Depth from original grade: 10 MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: SEE DWG. Ft. Gravel depth beneath pipe: 7.52/7.52 Ft. Subdivision: KNIK HEIGHTS Block: Lot: H 3 FII added above original grade: SEE DWG. Ft. Gravel length: 56/56 Ft. owns ip: anger - - ec Ion: - Gravel width: Beds Number of linea Distance between lines: 2.5/2.5 Ft. - - Ft. SEPARATION DISTANCES Total absorption area: 1680+ SQ. Fl. Number of trenches: 2 Disk. between trenches: 15 FL TO From Septic Tank Absorption Field Lift Station Holding Tank public/Private Sewer Lines Well 100'+ 100'+ - - 25'+ TANK ® Septic ❑ S.T.E.P. CHolding ❑Other Manufacturer: Capacity: Surface Water 100'+ 100'+ - - ANCHORAGE TANK 1500 cal, Lot Line 5'+ ,o'+ — — N/A Marial: te Number of comportments: STEEL 2 Foundation 5'+ 10'+ - - LIFT STATION Curtain Drain NONE KNOWN Manufacturer. Capacity: G.I. Remarks: 'Pump or, level at: "Pump off" t., alarm at: PER CONTRACTOR, OLD TANK WAS DECOMMISSIONED PER UPC Pump Make &Mode' ctrical Inspections performed by: PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer A+ HOME SERVICES Drainfield D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 111.55 Ft. Inspection Dates: 1st 6/30/14 2nd 6/30/1 Location and Description: 3rd 7/1/14 4th 7/2/14 BOTTOM OF T1-11 SIDING, SW CORNER OF HOUSE Community Development Department Approval Conditional approval: Date: ENGINEER'S S L oo�o Op p* 4 T �0 p...... ................0� 0 .. f A. Go ness.' Q CE- 3 �O �4pd profeeslooc a Approved: Date: 2- 2-/ I PERMIT NUMBER: PARCEL ID NUMBER: OSP141129 AS -BUILT . DRAWING 017-372-03 LC04 A B DBL1 13.61 56.13 DBL2 14.31 55.56 ST1 21.03 53.22 ST2 30.38 57.88 DBL3 32.42 58.89 DBL4 33.33 59.52 SUMP 48.80 45.60 C01 60.39 87.70 MT1 59.77 87.73 CO2 69.60 50.76 MT2 69.23 50.36 CO3 79.21 102.18 MT3 79.79 102.49 82.20 67.69 MT4 82.73 68.35 l 1\ KNIK HEIGHTS S/D; / BLOCK H, LOT 2 EXISTING DRAINFIELD TO BE USED AS ALTERNATE SITE (SIZED FOR 4 BEDROOMS) i Nur CoNr+E-r-AlF-m GREENHOUSE SUPPORTED ON SONO TUBES AND OVERHANGING DECK NOTE: FLOW SPLITTER LOCATION E IS APPROXIMATE. w STANDPIPE WAS NOT INSTALLED of L _ 100' WELL RADIUS a m EXISTING ST2 ST1 1 HOUSE SUMP \\� •• 04� NEW DRAINFIELDS NEW 1500 GALLON \ \ SEPTIC TANK \ GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E WNR ROAD. SURE 101 • ANCHORAGE M 99001 • PHONE (907) 337-6119 • FAX (907) 338-3246 • MSM ♦ 91neeN PREPARED FOR: PHONE NUMBER: PAGE NUMBER. CAMERON & MARLYS GILCHRIST 360-9414 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: KNIK HEIGHTS; BLOCK H, LOT 3 PNB TYPE OF WORK: DATE: AS -BUILT DRAWING 7/15/14 \ Irk .��P�E.OF q!♦♦i F * ; '0 ............. f A. Garn ss ' 1■ Qm CE— 12 �O.pROFESSI�� • P IDS P141129 AS -BUILT DRAWING INSULATION (PER CONTRACTOR) FINAL GRADE = 104.09-105.31 ST7 ST2 TOP OF TANK TOP OF TANK AT INLET = 100.41 \ / AT OUTLET = 100.41 j ) NEW 1500 GALLON INVERT OF BUNG SEPTIC TANK INVERT OF BUNG AT INLET = 99.78 AT OUTLET = 99.62 WEST TRENCH EAST TRENCH FINAL GRADE = 100.61-101.03 FORIGINAL GRADE 0. HIGHEST POINT= 99.64 FINAL GRADE _ 97.56-97.67 - 4" INSULATION OVER ENTIRE NF - ORIGINAL GRADE HIGHEST POINT = 96.81 FILTER FABRIC OF PIPE = 94.33 — 15' 4" INSULATION OVER SOUTH HALF OF TRENCH ONLY FILTER FABRIC INVERT OF PIPE = 97.16 OF TRENCH = 89.64 PARCEL ID NUMBER: 017-372-03 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 83.64 (DRY) BOTTOM OF TRENCH = 66.81 ELEVATION OF BOTTOM OF TESTHOLE = 80.81 (DRY) OF GARNESS ENGINEERING GROUP, Ltd =..,,;::,.., ,9 ....... CIVIL & ENVIRONMENTAL ENGINEERS 3701 E 1000R PMD, SURE 101 • MCHOM M M 98607 • PHOPE (B M7-6118 • FAX (607) O -3M • 1IEB n, w .Wmnwrplm n ..... . ...............i PREPARED FOR: - PHONE NUMBER: PAGE NUMBER: 0F : f r . GO e6 CAMERON & MARLYS GILCHRIST 360-9414 3 OF 3 0 J CE -79 3 LEGAL DESCRIPTION: DRAWN BY: KNIK HEIGHTS; BLOCK H, LOT 3 PNB ## .. FO F 41.. • r.. TYPE OF WORK: DATE: I;$;;::�� PROFILE AS -BUILT DRAWING 7/15/14 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141129 Tax Code Number: 01737203000 Work Type: Septic Upgrade Permit Effective Dates: May 28, 2014 to May 28, 2015 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: KINK HEIGHTS Site Legal Address: KNIK HEIGHTS BLK H LT 3 G:2836 Owner/Address: GILCHRIST CAMERON & MARLYS PO BOX 111845 ANCHORAGE AK 995111845 Site Mailing Address: 12900 BAINBRIDGE RD, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 43500 Total Bedrooms: 5 Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receive Issued MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 017-372-03 Property owner(s) CAMERON & MARLYS GILCHRIST Day phone 360-9414 Mailing address 12900 BAINBRIDGE ROAD *ANCHORAGE, AK Site address 12900 BAINBRIDGE ROAD *ANCHORAGE, AK Legal description (Sub'd, Block & Lot) KNIK HEIGHTS; BLOCK H, LOT 3 Legal description (Township, Section & Range) Lot APPLICATION IS FOR: ( Pall that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Sq. Ft. Number of Bedrooms 5 o U13MI T A ❑ MAY 2 0 2014 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: :?lO ' — Date of Payment: Receipt Number: m 15 CA V Permit No. O` PH 11 Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) APPLICATION IS AN: Initial ❑ ® Upgrade ® Renewal ❑ ❑ o U13MI T A ❑ MAY 2 0 2014 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: :?lO ' — Date of Payment: Receipt Number: m 15 CA V Permit No. O` PH 11 Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) GRNESS ENGINEERING GROUP, Ltd ` ��•_>---=CIVIL& ENVIRONMENTALENGINEERS- ,U May 6, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System for Knik Heights; Block H, Lot 3; To whom it may concern: The existing 5 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and needs to be upgraded (sized for 4 bedrooms). We are proposing to install a new 1500 gallon septic tank and a dual deep trench type drainfield. The old drainfield will be left in place for use as a future reserve site. Use of this drainfield will require service by advanced treatment or rebuilding. One testhole was excavated on the property. The new drainfields will be designed around the 30 foot radius of this testhole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached soil log which show 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 water concerns. 4. TOPOGRAPHY: As can be seen on the attached topograph�yy drawing, the average topography around the proposed drainfield is approximately 15%-7.R 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. A _.. M.S. 3701 East Tudor Road, Suite 101 *Anchorage. Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com ----------------------- FAIRMONT ROAD I I I I I I I I GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CAMERON GILCHRIST 907-360-9414 1 OF 1 LEGAL DESCRIPTION: DRAWN BY' KNIK HEIGHTS S/D; BLOCK H, LOT 3 A.J.G. TYPE OF WORK: DATE: SITE PLAN FOR SEPTIC UPGRADE 3/31/2( (Rev. 01M) m VAQUERO ROAD /�----�� KNIK HEIGHTS S/D. I KNIK HEIGHTS S/D; --BLOCK H, LOT 16 J LBLOCK H, LOT 1 -- , \\ ICONTOUR ACRES S/D #4; BLOCK 4, LOT 3 / 00' WELL RADIUS I i � I � I 00' WE.�L RADIUS_ s I I CSEPTIC � I \ /�I AREnD \ \ KNIK HEIGHTS S/D; I I KNIK HEIGHTS S/D; \ — —BLOCK H, LOT 17 J LE LOCK H, LOT 2 00' WELL RADIUS I Q /E�D KNIK HEIGHTS S/D; I I Of/ I. i --BLOCK H. LOT 16 J \ L-------- �� i'GJ o Q I __�—� r-------- /�'---�� RECSED �\ / I KNIK HEIGHTS S/D; BLOCK CSEPTIC �{\ ARFE� H, LOT 15 to = , I 00' RADIUS JWELL 00' WELL RAOIUS IKNIK HEIGHTS S/D; -------- J I BLOCK H, LOT 4 \L --_--- 1• = loo, GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CAMERON GILCHRIST 907-360-9414 1 OF 1 LEGAL DESCRIPTION: DRAWN BY' KNIK HEIGHTS S/D; BLOCK H, LOT 3 A.J.G. TYPE OF WORK: DATE: SITE PLAN FOR SEPTIC UPGRADE 3/31/2( (Rev. 01M) m NUMBER OF BEDROOMS: 5 / GALLONS PER DAY (GPD): 750 PERCOLATION RATE/S: 34.28 PROPOSED APPLICATION RATE: 0.45 MINIMUM DRAINFIELD SO.FT.: 1667 MAXIMUM DEPTH OF EXCAVATION: 10 FEET WIDTH: 2.5 FEET LENGTH: 112 FEET LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER ;ONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND — HEIGHTS BLOCK — — KNIKI2 LOT 2 EXISTING DRAINFIELD TO BE USED AS ALTERNATE SITE (SIZED FOR 4 BEDROOMS) —1 GREENHOUSE SUPPORTED ON SONO TUBES AND OVERHANGING DECK NOTE: THE CONTRACTOR SHALL HAVE THE NORTH & WEST LOT LINES, AND ALL WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. \X) \ / 1"= 40' y� / / TANK TO BE ) PER UPC. FCO IF ONE IS NOT PRESENT 100' WELL RADIUS o MI \ f 1 +> CO MT \� ST2 ST1 1 HOUSE EXISTING ' : ,^•: ;: W TH#1 + \\ \\ MT \ O CO cc M CO PROPOSED 1500 GALLIDIN SEPTIC TANK \ LDOUBLE C/O'S \ \ PROPOSED FLOW SPLITTER NOT&. / SYSfiEM SHALL Vt TIM T, D \ KNIK HEIGHTS 4 / a UTWg C,O,S.A APPI?OV.L \ BLOCK H, LOT 4 / A- S - / S f ° 1 `NT A. GARNESS ENGINEERING GROUP, Ltd :. .. CIVIL & ENVIRONMENTAL ENGINEERS 3M1 E. MOOR ROAM. SURE 101 a MONOWE, PI( 99507 •PHONE (W) 337-61]9 a FM (907) 336-3240 a WE95RE: 'aria.9onwaean inaarin PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CAMERON & MARLYS GILCHRIST 360-9414 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: KNIK HEIGHTS; BLOCK H, LOT 3 PNB DESIGN UPGRADE 14 u /9 S • "ROFESSO"o' FAIRMONT ROAD I I I I I I / / KNIK HEIGHTS S/D . I KNIK HEIGHTS S/D; / \ / --BLOCK H, LOT 16 J LWMIK H, LOT 1- -- - - - - - - - - ----------I �- -J� 00' WELL RADIUS I / I �I00' WELL LL RADIUS CSEPTIC \ \ I ARS \ \ \ KNIK HEIGHTS S/D; I I KNIK HEIGHTS S/D; /X — — —BLOCK H, LOT 17 J I_BLOCK H, LOT 2 1 I ?IWOO' SnERPTI S�D KNIK HEIGHTS S/D;BLOCK H, LOT 16J rCSERPTTIIC I KNIK HEIGHTS S/D; I I [SEPTIC BLOCK H, LOT 15 IW Y ARFE� / 00' WELL 00' WELL RADIUS --- I KNIK HEIGHTS S/D; — J �I BLOCK H_L0T 4 --- \ / I CALE: — 100' GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS' I E. MOOR ROIL, SURE 101 • AN00MGE, AK 99507 • PHONE (907)]3]-8179 • FAX (907)338—UM WEB81E: wvw.9ame,ven9l,aerM9.co ;EPARED FOR: PHONE NUMBER: PAGE NUMBER: CAMERON GILCHRIST 907-360-9414 3 OF 3 GAL DESCRIPTION: DRAWN BY: KNIK HEIGHTS S/D; BLOCK H, LOT 3 1 A.J.G. C OF WORK: SITE PLAN FOR SEPTIC UPGRADE (Rev. 01/05) 3/31/2013 VAQUERO ROAD ICONTOUR ACRES S/D #4; BLOCK 4, LOT 3 I � I I I I I / I I I I z Q Q GARNESS ENGINEERING GROUP, Ltd SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: KNIK HEIGHTS S/D; BLOCK H, LOT 3 PERFORMED FOR: CAMERON GILCHRIST DATE: 4/$/2014 DEPTH (feet) ORGANICS TEST HOLE #1 t ,e: 17 18 19 SP TO SM POORLY GRADED SAND W/ SILT & GRAVEL DEPTH TO GROUNDWATER DATE DRY 4/8/2014 SOIL CLASSIFICATIONS I I I I I TH#1+ I I t ` � � I I I I \ 1 1/8" 3 11:20 - 6" - a:.o: ---- -I? r— ••, \ I GW � % SITE PLAN ORG 3 30 :*: 7/8" GP ML :`s.. :-9: GM CL 4 V. GC OL •e: ••• 0000 o o•oo SW MH ' SP CH V. SM / OH 6 •• SC 17 18 19 SP TO SM POORLY GRADED SAND W/ SILT & GRAVEL DEPTH TO GROUNDWATER DATE DRY 4/8/2014 DRY 4/15/14 I I I I I TH#1+ I I t ` � � I I I I ice/ I I II J I EAIC \\ I \ KNIK HEIGHTS S/D; � LELOCK H. LOT 2 —I I r----------wl I / � � I I I I I I I I I I I TH#1+ I I t ` � � I I I I \ 1 1/8" 3 11:20 - 6" - 4 11:50 ---- -I? r— 7/8" \ I I I CSEPTTIIC � % SITE PLAN - 6 12:20 30 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/9/2014 1 10:50 - 6" - 2 11:20 30 4 7/8" 1 1/8" 3 11:20 - 6" - 4 11:50 30 5 1/8" 7/8" 5 11:50 - 6" - 6 12:20 30 5 1/8" 7/8" PERCOLATION RATE 34.3 (MIN./INCH) TEST RUN BETWEEN 5.0 FT. AND PERC. HOLE DIA. 6 (INCHES) 6.0 FT. 20 ' A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: ANDREW GRAY PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERCOLATION RESULTS ARE ACCURATE TO 1/16" PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PER 0 MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ® �1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 7.84-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPI-C'T'ION REPORT NAME UPGRADE MAI LING ADDRESp LEGAL DESCRIPTION d LOCATION J/ NO. OF BED;V?MS _ ye DISTANCE TO: Well Absorption area ,U a! l.tl 6 p Dwelling / % / PERMIT NO. �� 67/7 I- Q LU F Manufacturer � e r l -r �C !—� Materia No. of compartments N Liq. capacity ions IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. O Z Q T N Manufacturer Material Liquid capacity in gallons 8 LU - DISTANCE TO: Well/ Foundation / Nearest lot Iinc/ . / PERMIT NO. °j u z N- z w FTop 9 No. of lines / Length of cline i ' of tile to finish grade 1— Total lenth f 11 es Trench width g--� r _ _inches Material beneath the r/ 7,o7 Pinches Distance between it7'.y Total effective bsorption area Q Q w Length Width Depth �_ PERMIT NO. Q F- 0.0. LLI Type of crib --— Crib diameter Crib depth Total effective absorption area N DISTANCE TO: lNell Building foundation Nearest lot line Class /� Depth Driller Distance to lot line PERMIT NO.LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER LEGAL - I - - - PIPE MATERIALS y SOIL TEST RATING - INSTALLER REMARKS lU I 3 APP'/( DATE DEPHRTMENT �. 825 'L' 8��L.. 11L.- F1 PAK�> PERMIT NO. It 810177 ) \K ~ /r`/~0/\ . �~ '`~-- HEHLTH AND ENVIRONMENTFit- ,KOT2CTION STREET, HNCIPIORHGE, HK. 99501 , 264~4720 ^ -~��1~�� '�' � ��~ � HPPLICHNT R&H CONST INC 4811 BISHOP WHV��^ \`\« � ��Sx/��'`` /` `� � �]�—l6/4 '/�l1 LOCHTION BHIN8RIDGE OFF HUFFMHN [�U[/ '' LEGHL L] BLOCK H KNIK HTS LOT SIZE 42000 SQUHRE FEET TYPT OF ABSORPTION SISTEM IS: TRENCH MAIMll"! NUMBEER OF GEDROOMS = 4 SOIL RF:iTJNG 150 THE REQUIRED SIZE OF THE SOIL 19135OAPTION SYSTEM IS: =11-1.4-- -1- C.D L~ 144 CIO W 1-1 =wm TJ N_�f"--f %0 F.H. I_. �EE- THE LENGTH DIMENSI0N IS THE LENGTH OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIIUM DEPTH OF GRHVEL GETWEEN THE OI.YTFHLL PIPE HND THE BOTTOM OF THE (IN FEET). ��E L.9 1: E'.I: Un-, ��T, 1 �lt�-o 0-%-. 1: U-1 ��!.5 CE.11 ��L_ V-4�� PERMIT HPPLICHNT HHS THE RESPONSI�ILlTY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHC: ENT TO THIS PROPERTY HND THE N�M�ER OF FREE SIDENCES THAT THE WELL SERVE. �_ -11", A I Q < �_-? ..-H J.: P-4 10 W EE Q -T 1 0 VA 05; fl EE G.7!! 0.3 1 F:�", r..,.,: 1� �--_ BACKFILLING OF HNY SYSTEM WITHOUT FINAL HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON~SITE SEWAGE DISPOSHL SYSTEM IS 100 F��T FUR R PAIYATE WELL OR 150 TO 200 FEET FR -IN H PUBLIC WELL DEPENDING T-iiTYPE OF PUBLIC WELL MINIMUM DISTHNCE. FROM H PRIVATE WELL TO G PRIVATE s,ENER LINE IS 25 FEET HND T� H COMMU�ITY SEWER LINE IS 75 F:*EET. WELL LOG_:.; AF -!E REQUlRET) AND MUST BE RETURNED TO THE DEPH?.'Tr-*IENT CIA IT' S Of THE WELL COMPL�TION OTHER REQUIREMENTS MAY APPLY. HND CONSTRUCTION DIHGRHMS HIRE RVH�LHBLE TO INSURE PROPER INSTHLLHTION FWEAVIN x W KNUM, 1 �Q Q FE -H 1--1 ID EE �� [ CERTIFY THAI 1: I AM FRMILIAR 141TH TFIE REQUIMMF-ENTS FOR HND WEL-S AS SET FORTH 13Y TFIE MI NICIPFIIATY OF H�CHORHGE. 2� I WILL INSTGLL T�� SY�T�� IN HCCCIRDRNCE WITH THE CODES ]� � ��DERSTHND THHT THE ON~SITE SEWER ��TEM MAY REQUIRE ENLHRGETENT IF THE RESIDENCE IS REMODELED TO PNCLUDE MORE THAN 4 ��DROOMS SIGNED:~ ��~~~.... .~�~—� HPPLICHNT R&H NC ISSUED BY ^_--�~ Y40 :A CONSTF-`JCT10N .� x TEST LAB PERFORMED FOR, R & H CONSTRUCTION LEGAL DESCRIPTION: THIS FORM REPORTS 18C W 48TH AVE. STE. SCI ANCHORAGE, ALASKA 99503 248-1333 DATE PERFORMED: 4/15/81 Lot_ Block_ H Subdivision_–_Kbsi{–S3F..IGHTS — XVisual Shcs Examination 0 Percolation Test DEPTH SOIL crCr nFg(-.RIPTI ON NOTES _ J J ✓ Overburden Brown r BOTTOM OF HOLE I _ .0. f. WAS GROUND WATER ENCOUNTERED_ No v IF YES, WHAT DEPTH' •e °°°°'•`°"' LEGEND �� :•` Q F' °• K:nney R. ter -- Perc Zone �Q °•• 3655 - E �D S - Sample taken @ F •° Poorly Graded Tan w/ A.;•, Gravelly Sand slight 150sf/br trace of silt I I I j I� — Y III _II1 _AIN 1 W O J U) W t - LO Z w cD If 1 _ 1.1�-J BOTTOM OF HOLE I WAS GROUND WATER ENCOUNTERED_ No v IF YES, WHAT DEPTH' •e °°°°'•`°"' LEGEND �� :•` Q F' °• K:nney R. ter -- Perc Zone �Q °•• 3655 - E �D S - Sample taken @ F •° t� -- Frozen zone If 1 _ 1.1�-J I -1 �� J 1--l-j- 1- 1 TIi � q I I I I j I� iJ ll___I -T_J__- III _II1 _AIN 1 -T j- -j I i I I I IJ J J J -I {- If 1 _ 1.1�-J GENERAL SITE SLOPE PERCOLATION RATE: DRAINAGE REQUIREMENTS_150sf/br PROPOSED INSTALLATION: 0 SEEPAGE PIT JA DRAIN FIELD O OTHER COMMENTS :------. -- -- iINAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 3 / 17 18 1. GENERAL. INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) GO 13exrn (b) Applicant Name — n son _ Telephone: Home 3 YS -53 73 Business 269 - S-707 Applicant Address a 9Ga (jeirn br t RSC Prnehor (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ®'; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution _ Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: ---�er.0 /`(oor� F'lcc�i/aP Tec/7�rcu/ S-erycc� -- ! ys-3 o E c� S � f}nchoo 74(.r 1-295�6 - - r"/t ?1V -13S' cvtion V'eac%v 2. TYPE OF RESIDENCE Single -Family S Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well 0 Community ❑ Public ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 0 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 z-nzsirvoal ti 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION I 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 this inspection. Name of Firm FlctPOP 7!c64 ica/ Stet eel, _ Telephone 3 13E _ Address f -C 99,5 --id Date - Mctrcti lG, 1986 6. DHEP APPROVAL Approved for _o --- Approved 1A tk 10 ... .................. .:...� •. THEODORE F. MOOR[ a®�,•.• CE - 3589 •, �� Engineer's Seal bedrooms by ^ �' �%P' "" Date Disapproved Terms of Conditional Approval Conditional 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. Pane 2 of 2 A. WELL DATA Well Classification _ Prry«Fc _ If A, B, C, D.E.C. Approved (Y/N) NtA, Well Log Present (Y/N) N Date Completed Yield Total Depth I rO' f Cased to '—.v 10' Depth of Grouting Af4t Static Water Level $m' i Pump Set At Un lTnawn _ Casing Height Above Ground Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot I I `I ; On Adjoining Lots 7 100' IV To Nearest Edge of Absorption Field on Lot (2S' _ ; On Adjoining Lots 7 (vv' To Nearest Public Sewer Line N..4.. _ To Nearest Public Sewer Cleanout/Manhole _ PLA — To Nearest Sewer Service Line on Lot t•i,�}. Water Sample Collected by — Date 3 / 13 /,,(- Water Sample Test Results — Sccits��Y — ND cmhlorrn beted-ert"at Comments We(I S�(uw 4-"1- (�= no2uclect a /eY by r4G-_Cs B. SEPTIC/HOLDING TANK DATA Date Installed lBl Size Ict No. of Compartments Standpipes (Y/N) —_— Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped _ 3111( /Or Pumping/Maintenance Contract on File (Y/N) N, A• _ ; for N. A, Holding -rank High -Water Alarm (Y/N) .1 _ Temporary Holding Tank Permit (Y/N) lN-f1• Separation Distances from Septic/Holding Tank: To Water -Supply Well — If W To Property Line To Water Main/Service Line Course '7 (coo Comments Pagel of 2 0 To Building Foundation _ to, To Disposal Field _ s r To Stream, Pond, Lake, or Major Drainage MUNICIPALITY OF ANCHORAGE _ DEPT. OF HEALTH & MUNICIPALITY OF: ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (MAA) MAR 17 7(JBV' CHECKLIST - FEBRUARY 1984 264-4720 cK ' VED Legal Description: �a- !3� 1-c'n i k H AX .S /L A. WELL DATA Well Classification _ Prry«Fc _ If A, B, C, D.E.C. Approved (Y/N) NtA, Well Log Present (Y/N) N Date Completed Yield Total Depth I rO' f Cased to '—.v 10' Depth of Grouting Af4t Static Water Level $m' i Pump Set At Un lTnawn _ Casing Height Above Ground Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot I I `I ; On Adjoining Lots 7 100' IV To Nearest Edge of Absorption Field on Lot (2S' _ ; On Adjoining Lots 7 (vv' To Nearest Public Sewer Line N..4.. _ To Nearest Public Sewer Cleanout/Manhole _ PLA — To Nearest Sewer Service Line on Lot t•i,�}. Water Sample Collected by — Date 3 / 13 /,,(- Water Sample Test Results — Sccits��Y — ND cmhlorrn beted-ert"at Comments We(I S�(uw 4-"1- (�= no2uclect a /eY by r4G-_Cs B. SEPTIC/HOLDING TANK DATA Date Installed lBl Size Ict No. of Compartments Standpipes (Y/N) —_— Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped _ 3111( /Or Pumping/Maintenance Contract on File (Y/N) N, A• _ ; for N. A, Holding -rank High -Water Alarm (Y/N) .1 _ Temporary Holding Tank Permit (Y/N) lN-f1• Separation Distances from Septic/Holding Tank: To Water -Supply Well — If W To Property Line To Water Main/Service Line Course '7 (coo Comments Pagel of 2 0 To Building Foundation _ to, To Disposal Field _ s r To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata fsa j0' //3c(rn Type of System Design 7—ren c h Date Installed .5'/ r5- / & Length of Field 53 Width of Field 3 " Y, Depth of Field `f ` MOA No. SSS —O,C Gravel Bed Thickness 6 Square Feet of Absorption Area 63(5' Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 7 Results of Last Adequacy Test Su ks fn c /or c�Cr oomr °+• e• 6 s f�'••+�°�'�� • +'.� Engineer's Seal Separation Distance from Absorption Field: Amount: $ To Water -Supply Well f 2,S1 To Property Line To Building Foundation > 3 0 ` To Existing or Abandoned System on Lot N,& ; On Adjoining Lots 7' 3 G ` To Water Main/Service Line To Cutbank (if present) 1111 F%• To Stream/Pond/Lake/or Major Drainage Course 7 Cv0 THEODORE F. MOORE :• ® . - •, CE - 3589o� To Driveway, Parking Area, or Vehicle Storage Area Comments Aucccx {-csf eer �o r -m tGC 7/20 l6 72-026 (11/84) D. LIFT STATION N• A. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) — "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA " Check 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 Date Mcurcy /6, /986 Company Tech S `c r MOA No. SSS —O,C Receipt No. �5 7�� At 44 Date of Payment j� °+• e• 6 s f�'••+�°�'�� • +'.� Engineer's Seal F t3�': Amount: $ �� + �t�TFi �`��®� yy� °s Page 2 of 2+®fit THEODORE F. MOORE :• ® . - •, CE - 3589o� + "ProfmiO 72-026 (11/84) �4 t VAVAlk 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAI. HEALTH DEPARTMENT OF H1=TH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AU'T'HORITY APPROVAL CERTIFICATI: 44 1. General Information Application Date (a) Ligal,Desjjiptioln,(include lot, block, subdivision, section, ltownship, range) n (.-}ddress, or directions) (b) Applicants Name Applicants Address �-1ele hone •- Home Business (c) Applicant is (check one) Tending Insp*,i.tution ; Owner/builder Buyer , Other (explain); (d) Lending Institution Address (e) Real Estate Co. & Agent Address Telephone (f) Mail. the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms Tel�!Etione MUNICIPALITY OF ANCHORAt3E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 'AUG 71084 RECEI\(ED Other (describe) q �� 3. HatrZ ly Individual Well,11 � Communi.Community� Public .,.<'._ Note: If community well system, must have written confirmation from the State Department. of Envirorunental Conservation atteuting to the legality and status. 4. Sewage Disposal Onsite Public Community � Holding 'Dank E—A Note: If community well system, murs`b have written confirmation from the State Department of Environmental Conservation att:estl.ng to the legality and status. [Page T of: 21 5.ineering Firm Providing InsElctions,_Tests1_Fiille 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date 6. DEEP Approval E o o' It (ENGINEER SEAL) Approved for _ bedrooms By Approved. - Disapproved Terms of Conditional Approval CAU'T'ION SUO.LI_ Telephone_,5(C,/-- (C/-- Conditional (� THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAI' ENGINEER REGISTERZD IN THE STATE OF ALASKA. THE DIIEP DOES THIS AS A COURTESY TO PURCHASERS OF (-TOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CURTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONST.BI FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DEEP SEAL) RR4/ej/Dl8 [Page 2 of 2 ] 7-19--84 �� a tl INK 4P"Ilk ^� tf�aS��' � 'f Vii. U � .4��• g 000P9^449dq ii4B£OB 61BB9c!: r,J2.s J:J �I pJ B94( 29j1 e 1,10 Conditional (� THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAI' ENGINEER REGISTERZD IN THE STATE OF ALASKA. THE DIIEP DOES THIS AS A COURTESY TO PURCHASERS OF (-TOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CURTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONST.BI FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DEEP SEAL) RR4/ej/Dl8 [Page 2 of 2 ] 7-19--84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL EATA Legal Description: P'oLk Well Classification If A, B. or C, D"".��E.C. Approved(Y/N) IvIt, Well Log Present (Y/ Date Completed Yield 5.D� Total Depth 150 a- Cased to �6_ �OG1 Depth of Grouting �D 1 o!� V_ _—"- Static �— Water Level �� Pump Set At�V- Casing Height Above GroundSanitary Seal on Casing OI) Electrical Wiring in Conduit N) Depression Around Wellhead (YAM Separation Distances from Wall: To Septic/Holding Tank on Lot �� o On Adjoining Lots To Nearest Edge of Absorption Field on?Lot Of On Adjoining Lots To Nearest Public Sewer Lie M JA To Nearest Public Sewer Cleanout/Manhole----b A To Nearest Sewer Service Line on Lot ,N Water Sample Collected By 1WJEjM f:1C ; Date Water Sample Te t Results Canments e_o_SSuP ed leo n1 B. SEPTIC/HOLDING TANK DATA Date Installed J i5 Size _ t 25U No. of Ccxnpartments 2 Standpipes (ON) Air -tight Caps ON) Fundation Cleanout (ON) Depression over Tank (Y/I@ Date Last P1 d � Pumping/Maintenance Contract on File (Y ) A ; for lid 1 114 Holding Tank High -Water Alarm (Y ) Temporary Holding Tank Permit (Y/N)/VI ,+ Separation Distances from Septic/Holding Tank: To Water -Supply TAbll 00.4- O — To Building Foundation To Property Line D] To Disposal Field J To Water Main/Service Lire �� To Stream, Pond, Lake, or Major Drainage 1n Course Comment [Page 1 of 21 2 -is -a4 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata \S d Type of System sign-Ck.eo('�� Date Installed ' 81 Length of Field _-53 Width of Field i _ Depth of Field Gravel Bed Thickness �0 Square Feet of Absorption Area 4 00 ® Standpipes Present ) _� Depression over Field .(ON) Date of Last Adequacy Test '77 2,C) 8 Results of Last Adequacy 'lest 6 - c --6v,( Separation Distance from Absorption Field: To Water -Supply Well O d} 6) To Property Line _ 2.�+ To Buildin Foundation 2A, To Existing or Abandoned System on Lot (� On Adjoining Lots 20 t I To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area�'U,+_ Cormtients 0 nAEQs ( W- F-1) � o_cr�rl �` O�7j i� S SAS . cwt I lel s 1 D. LIFT STATION 1` Date Installed Dimensions _ Size in Gallons _ �- nh le/Acce "Pump On" Level at "Pump Of t -t High Water Alarm level at Ve Tested for Pumping Cycles r Electrical Codes(YM) Convents at Adequacy Test. Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all. MOA PAA Guidelines in effect on the date of this inspection. Signed �XiZU�� •�liYtny/2, Date r '�(� /(T"� ��Q°��`.�F •�:;�� to Company C L a MOA No. l�baA& S e' o�P Q KB1 /d5/s [Page 2 of 21 e)- -/07 )--/G`% 2-15-84 ALASKA b dROf1 PTAL COWROL SNOIC65, IX Cngineerinq & Cnuironmenlal Studies AUGUST 6 1984 BRUCE BEADELL 4105 TURNAGAIN BLVD ANCHORAGE AK 99503 SELLER — .TEFF ROSS BUYER — PHILLIP HANSON SUBDIVISION — KNIK HEIGHTS BLOCK — H LOT — 3 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 600 SOFT. THE SYSTEM IS CAPABLE OF ACCEPTING 720 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 600 GALLONS. BASED UPON THE, TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME, THE SEPTIC TANK WAS PUMPED ON 7/27/84 FLOW TEST ON WELL THE WELL FLOC' RATE WAS 4.6 GPM MR 2 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. lsl4'* ; SON6D.(QYj�"9 �90au00aa003qu .:�:., '��i ♦� 9� k � N v I �!p��}�it��aicB boc�enrno o f l01 S18�C�A�Ci. A oCoo x.16% °u C.S;t A� 10% Lei.C. Reid, Jr. 'o Y F r,, 1200 UJesl 33rd Auenue. guile B • AnAorage. Alasko 995039'907) 561-5040 5. LEGAL DESCRIPTION -- STREET LOCATION - i _ L o A 6. TYPE OF RESIDENCE NUMBER OF,B D MS ( SINGLE FAMILY 0 One �0 Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three E7 Six 7. WATER SUPPLY — �] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM -- INDIVIDUAL/ON-SITE** __YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -- —ter -----� 72-010 (Rev. 6/79) —�e DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE - DATE- p l INSPECTOR INSPECTOR - INSPECTOH MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE / .DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPI. OF HEALW & - 825 L Street - Anchorage, Alaska 99501 PICIfECTION ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION � L� 791 Telephone 264-4720 ��yy REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW fik)Ccb WsD DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER 1 11 PHONF 1C)v\ Y) C a lj Fj� Li MAILING ADDRESS - tSdf PROPERTY RESIDENT (If different from bove)— I HONE 2. BUYER — PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS — 4. REALTOR/AGENT — -- PHONE A�Qb-6��,C_7) MAI LING ADDRESS 5. LEGAL DESCRIPTION -- STREET LOCATION - i _ L o A 6. TYPE OF RESIDENCE NUMBER OF,B D MS ( SINGLE FAMILY 0 One �0 Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three E7 Six 7. WATER SUPPLY — �] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM -- INDIVIDUAL/ON-SITE** __YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -- —ter -----� 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY Cl INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 9�1—' APPROVED FOR cy BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE �1 BYE