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MAJESTIC VALLEY ESTATES BLK 4 LT 3
M aj e st*c Va'lley Awl #050-731-30 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221307 PID Number: 050-731-30 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New A Upgrade Name Thomas Dawson & Patricia Walsh ABSORPTION FIELD Site Address 25928 Imperial Drive ❑Deep Trench ® Bed Mound ❑ Wide Trench ❑ ❑ ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.0 GPD/SF 1.8 / 1.4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.1 / 0.7 Ft. Gravel depth beneath pipe 0.7 Ft. Subdivision Block Lot Majestic Valley Est 4 3 Fill added above original grade 3.5 / 4.5 Gravel length 45 / 45 Township Range Section Ft. Ft. Gravel width 5/5 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 450 Ft2 2 6 Ft. Well >100' > 100' N/A N/A >25 TANK M Septic ❑ S.T.E.P. [:]Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water >100' > 1 00' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation > 10' > 10' N/A N/A IL4FT STATION Manufac u Capacity Remarks Trenches listed north / south Gal. Alarm location Zft Electra Iled by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Reid Pomraning Drainfield D3034 CO/MTD3034 Inspector L. Tidwell / B. Schiller BENCH MARK (Assumed elevation) 100ft Inspeection 15t 10/27/22 2 d 1 1 /2/22 Location and description 3'' 11/2/22 4w Back deck @ South side of house ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF4,9 Conditional Approval: Date ��Q'`�' •:��� TH �,y Benjamgn Schiller :� j Septic System Approved Date �• F� CE 12592 5/24/23 PROFESS0'N Note: this approval does not include well permit requirements. �� (Rev 05/02/18) MAJESTIC VALLEY ESTATES, BLOCK 4 LOT 3 PERMIT # OSP221307 PID # 050-731-30 B3®9\ ` yam— \��\\ \ \ //(gyp \�\ \ / \B3L10 / /_ \\ \ iLOT2�\® CFCO \\ \ \ EXISTING TRENCH PLACED\DIN CMDT22 ,} TH#1 \ o \ \ \ \ CO3 �� \ 1 �. \ \MT �� \ \ \ 2-45' LONG x 5' WIDE, 0.5� \ FS \ \ ^EFFECTIVE,DEPTH ABSORPTION \TRENCHES W/ 2' SAf�DLINERS TH#2 MT4 C04 \ \ \ L04. \ \ --,',LOT 3 \ \000-GAL ALTERNATE SITE: \ \ �—��EPTICTANKW20'LONG x 5'�IDE, 0.5' \0"M%9�1WAY j \ \ � FFECTIVE DEPTH,CATIII � \ \ AB�ORPTIQN TRENCH 20{CITY�EgSEMENI� _� BLOCK 1 LOT 4 9.0 \ \\ I BLOCK j LLOT 3 � \ I \ - /'- -BLOCK 1 LOT 2 -`'� i EN G 1 N EERI N G �_y>�`\\\\ A B LEGEND �` 1 *4sTM9*�i PLAN AS -BUILT •�� ........... 0 50 100 Benja i Schiller ���F•• CE 25s2 FEET5124121 ili`��PROFESSIONP'.� FS 43.8 30.4 C01 38.6 30.5 MT1 35.8 28.2 CO2 24.6 58.9 MT2 25.8 59.0 CO3 36.1 66.0 MT3 37.2 66.4 C04 46.0 41.2 MT4 47.6 44.1 MH 19.0 57.7 SV 14.8 62.0 2C0 10.8 66.4 CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT- MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE MAJESTIC VALLEY ESTATES, BLOCK 4 LOT 3 PERMIT # OSP221307 PID # 050-731-30 0 0 73 91.4 FINISH GRADE 17.9 ORIGINAL GRADE 86.8 DRAINFIELD ROCK 86.8 86.1 MOA APPROVED SAND 86.1 84.1 84.1 45' NORTH TRENCH NO GROUNDWATER 7/27/22 77.4 Co cy) 0 F- F- 0 90.9 FINISH GRADE 86.4 ORIGINAL GRADE 85.7 — DRAINFIELD ROCK 85.0 — 85.7 MOA APPROVED SAND 85.0 —83.0 83.0 45' SOUTH TRENCH NO GROUNDWATER 7/27/22 77.4 .7H . ... ... . ...... .......... .......... PROFILE AS -BUILT ja BenCE 1259Schiller 2 . .5/24/23 (NO SCALE) . ...- �� AW k�.,--'PROF�SSO� ' E.. GE SOILS LOG AND PERCOLATION TEST ENGINEERING LEGAL DESCRIPTION: MAJESTIC VALLEY ESTATES, BLOCK 4 LOT 3 PERFORMED FOR: JACK SHEPPARD DATE: 10/27/2022 PARCEL ID#: 050-751-30 DEPTH TEST HOLE 2 (feet) 1 I I OB DATE READING START TIME NET TIME DEPTH TO WATER NET DROP (MINUTES) (INCHES) (INCHES) 2 7/13 1 4:00 5:45 0 6 6 :. PERC TEST LOCATION 2 4:10 5:23 0 6 6 4 ,' 3 4:16 5:44 0 6 6 5 GM W/ LARGE WELL -GRADED 4 4:22 5:50 0 6 6 ROCKS 6 r 5 4:28 5:46 0 6 6 6 4:34 5:47 0 6 6 7 r .. 8 -' . t . 6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING 9 PERCOLATION RATE: <1 (MIN/INCH) B.O.H. 1 SITE PLAN 11 12 13 1 1 16 17 18 19 NO WAS WATER ENCOUNTERED? - IF YES @ WHAT DEPTH? DRY DEPTH TO WATER AFTER MONITORING 7127122 DATE OF MONITORING COMMENTS: USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED TECHNICIAN: L. TIDWELL / h VE 8s R, WELL 3S5.00, S �s'21'10» ��• 45.00, Lot 2 4 1.2'x4.2' CANT ij c v / /—SEPTIC 8.5'x12.3' M o Q<vn PIPE � \ COOP \ V) co 4�e p ,f;, --MANHOLE OEC O' // PIPES SEPTIC 2� Lot 3 54,480 S.F. Lot 4 SEPTIC PIPES :�=• • C14 Lot 4 w 960 20' ULITY s' -� TEASEMT1':NT I 00 17"w 1 0 , ""r-- I Lot 3 I I I Lot 2 I PLOT PLAN __— AS BUILT _X_ SCALE _ 1 " 60' _ GRID SW 0363 Project No 22-4001A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax �4400��pp Professional Land Surveyors ken®langsurvey.com (� F jonothan0langsurvey.com I hereby certify that I have surveyed the following described property:Tyo0 LOT 3, BLOCK 4, MAJESTIC VALLEY ESTATES SUBDIVISION (PLAT No. 77-27) 49TH Anchorage Recording District, Alaska, and that the improvements situated thereon are"""' "" """""""Q 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 Qn '• KENNETHjj LAN�� easements on said property except as indicated hereon. V �� ����[s Dated this the l v` l} L� u' F� S-5202. •'' r,Jp© Day of �1� n=______, ______, at Anchorage, Alaska Q o O o �4p oreSS1oN 4`�Qa It is the responsibility of the owner to determine the existence of any easements, pppoo covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE 1»ent On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road ,~ ti*c • . Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite v06d Department On -Site Wastewater Disposal System Permit Permit Number: OSP221307 Effective Date: 8/17/2022 Work Type: Septic Upgrade Expiration Date: 8/17/2023 Tax Code Number: 05073130000 Site Legal Address: MAJESTIC VALLEY ESTATES BLK 4 LT 3 G:0363 Site Mailing Address: 25928 IMPERIAL DR, Eagle River Owner: DAWSON THOMAS M & Lot Size in Sq Ft: 54480 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 0//7/;?—' Z MUHMPAUTY OF AHCHORAG 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. 050-731-30 Property owner(s) Thomas Dawson & Patricia Walsh Day phone Mailing address PO BOX 770432, Eagle River, AK 99577 Site address 25928 Imperial Dr, Eagle River, AK 99577 Legal description (Sub'd., Block & Lot) Majestic Valley Est Block 4 Lot 3 Legal description (Township, Range & Section) Lot Size 54,480 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Fieldx❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑x Upgrade ❑x Duplex (D) ❑ Holding Tank ElRenewal ElMultiple 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: 4 5015 Waiver Fees: Date of Payment: g 131 �� Date of Payment: Receipt Number: Receipt Number: Permit No. 0 S10-? .� 13 G7 Waiver No. Permit App_::- : :'-..:c August 17, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Majestic Valley Est B4 L3- 25928 Imperial Dr. Septic system design Dear On-Site Services Engineer: The current septic system on the above lot has reached the end of useful life. There is an existing 3-bedroom home on the property, so we are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well as the well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes slightly toward the south of the lot. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 8’ away. Please refer to the attached test hole logs along with the plan and profile pages 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 OSP221307, Deb Wockenfuss, 08/17/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 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 LEGEND2COTH#1 MAJESTIC VALLEY ESTATES, BLOCK 4 LOT 3 FEET 0 50 100 ≥10' FS NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. IM P E R I A L D R I V E 3-BDRM HOME7/28/22 20' UTILITY EASEMENT 5 3 0 5 4 0 5 5 0 5 6 0 5 7 0 5 8 0 5 9 0 6 0 0 1000-GAL SEPTIC TANK w/ 20" MANWAY 2-45' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCHES W/ 2' SANDLINERS ALTERNATE SITE: 20' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH CATIII ABSORPTION TRENCH DECOMMISSION EXISTING TANK PER U.P.C ABANDON EXISTING TRENCH IN PLACE CONFIRMATION TEST HOLE MT MT MT MT CO CO CO CO ≥5' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221307, Deb Wockenfuss, 08/17/22 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER4" PERFORATED PVC (HOLES DOWN) 5' 6" 6" 2'-6" 6" DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 1.0 GPD/SF 5' WIDE TRENCH SYSTEM 1000-GAL SEPTIC TANK BOTTOM OF TRENCH: 3.5' BELOW GRADE FLOW LINE ELEVATION: 3.0' BELOW GRADE TOP OF TRENCH: 0.5 ' ABOVE GRADE 450 GPD / 1.0 GPD/SF / 5' WIDE * 1 (RED. FACTOR) = 90 LF TRENCH REQUIRED 8/16/22 GEOTEXTILE FABRIC 2' MAJESTIC VALLEY ESTATES, BLOCK 4 LOT 3 DRAINFIELD ROCK MOA APPROVED FILTER SAND Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221307, Deb Wockenfuss, 08/17/22 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? <1 7/13 1 2 3 4 5 6GM W/ LARGE WELL-GRADED ROCKS Professional Engineers Stamp: no Majestic Valley Estates, Block 4 Lot 3 7/13/2022 050-731-13 CLIENT 11:301 2 3 4 5 6 0 OB 0:40 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER7/28/22 PERC TEST LOCATION TECHNICIAN: L. Tidwell 6 - dry 7/27/22 COMMENTS: 6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING SITE PLAN 6 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED B.O.H. 11:32 0 0:48 6 6 11:34 0 1:01 6 6 11:35 0 1:04 6 6 11:37 0 1:05 6 6 11:40 0 1:06 6 6 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221307, Deb Wockenfuss, 08/17/22 Lot 2 Lot 4 o Q�'� s S6. R 3� RSF /44 I WELL G f��F OP 2F o �9r 0 m M \ 8.5'x 12HED ` SHED o N \ DE( Lot 3 54,480 S.F. OR\� 1.00, S 01,1pE 5 1.2'.4.2' :- CANT \ PIPES ;, Lot 4 20' UTILITY EASEMENT I N 81'00'17"WW 194.00• Lot 3 I I Lot 2 I PLOT PLAN ___ AS BUILT —X_ SCALE _1=_= 60__ GRID _ SW 0363Project No. ____Z2_4001A1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n c . (907) 522-6476 Phone 0000�pOO Professional Land Surveyors (907) 592-46y5 Fax —' OF A����4 kenOlan surve com jonathanOlongsurvey.com G� .• S Q I hereby certify that I have surveyed the following described property: LOT 3, BLOCK 4, MAJESTIC VALLEY ESTATES SUBDIVISION (PLAT No. 77-27) 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 LStM Day of ��`�-', ?" Lc—_, of 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. a� KENN LANGo� �4�9FO'.. LS -5202.•' gJ� 4�OnROFFSSIONA�- 00 AECC963 Municipality of Anchorage Page of :2r— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: yD 3i2PID Number: s2erD - P3/ -'30 Name: Wastewater System: ❑ New ❑ Upgrade Address: • ABSORPTION FIELD Phone: -- Q 3931� No. of Bedrooms: 3 ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound that LEGAL DESCRIPTION Soil Rating: Total Depthfrom o nal grade: Lot: Block: 3 Subdivision: PD/S . Pt. Depth to pipe bottom from original grade: Gravel depth beneath pipe / TiG .}ii! E . Ft. Township: Range: Section: Fill added above original rade: 9 9 / Ft. Gravel length: WELL: ❑ New ❑ Upgrad Gravel width: !�)f Ft. Number of lines: Distance between linea: Classification (Private, A,B,CI: Depth: Cased 70: Ft. Total absorption area: Ft. Pipe material Ft. Ft. Driller: 4`�)r Dete Drilled: Static Water Level: V 1 SO. Ft. Insta Date installed: Ft. Yield: Pump Set at: Casing Height Above Ground: GPM Ft. Ft. TANK SEPARATION DISTANCES p(Septic ❑ Holding ❑ S.T.E.P. To From septic Tank Absorption Field Litt Holding ublidPdvete Manufacturer: Capacity In gallons: Station Tank Sewer Llnae A DSO Well t�B� ,� i I ly Materiel' Number of Compartments: a,e`c z Surface Water t/o®' f Jo0 +wo r LIFT STATION Lot Line dS / tip 1fb / Size in gallons:Manufacturer: Foundation •f, .s f f to / "Pump on" level at: "P 1' evel et: High water alarm at: Curtain Drain +� i fSp f lsO / T Pump Make Electrical Inspections performed by: Remarks: ;t A10A►G own) . BENCH MARK F�iic f9vr .f7.0 6.IaeH Location and Description: yr e o w/. GoP¢�tsy ew• 01. Assumed Elevation: Ft E Inspections performed by: L-N-rS h/r2r9N Dates: 1 st 9169 2nd Department of Health and Human Services = NIRISTDPI ER P.WOOD -; �'', C'7 approval �Reviewed and approved by: Date: . �O sstWF'%- 72-013 (Rev. 9/911 MOA 25 Permit No. SWO40312 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MAJESTIC VALLEY ESTATES Bl. K 4 LT3 SWING TIES C 28.7' 23.8' SCALE 1".80' IMPERIAL DRIVE PID No.: 050-731-30 0' 1.0"W 'UnUP( FJSMENT SEPTIC TANK REPLACEMENT ONLY EASEMENT -- -- — PROPOSED LEACH FIELD o EXISTING LEACH FIELD ¢ B0� — DRIVEWAY ELEVATIONS (NOT TO SCALE) n BOTTOM OF SIDING AT 'A' ASSUMED ELEV s100.W „ 92.6' 92.1 - MONITOR TUBE - SEWER CLEAN OUT WELL - TEST HOLE L. +4 NEW 1,000 GAL TANK 92.6' 91.9' 8/23/04 ENGINEER'S SEAL STOPHER WOOD CE -10387 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO40312 Legal Description: mak" a7 [ _ALLEY i STATES s 4 IT""3 Design Engineer: 0024 Eagle River Engineering Services Owner Name: TOMAS DAWSON Owner Address: P.O. BOX 770432 EAGLE RIVER, AK 99577-0000 Date Issued: Aug 03, 2004 Expiration Date: Aug 03, 2005 Parcel ID: 050-731-30 Site Address: 025928 IMPERIAL DR Lot Size: 54480 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. Received B. Covered, sealed, and heated to prevent freezing. IN% Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OS D - 7 3 / - _3 O Permit Number SW Property owner(ss e9 A,1 Day phone Cam, — FSD 77"Zr Mailing address (1) -7,7D V32— P i—E•a -4k Mailing address Zip Code Legal description (Lot, Block & Sub'd.) N��✓ri-Tmnc 4ZI.WX e4ar arga eez.r y,C7-.3 Legal description (Section, Township & Range) TCF .? 3 iA Lot Size ,G,2 cre /Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit' ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Familypeeiling a�a* in epcordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: y310 Waiver Fees: _ Date of Payment: 7/Z 3�y Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Road Suite 201 Eagle River, AK 99577 July 27, 2004 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Majestic Valley Estates L3 B4 Narrative & Permit Application Dear Mr. Roth: (907) 694-5195 tel (907)694-3297 fax The proposed septic tank replacement will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance, and wells +100' 3. This permit is for replacement of the septic tank only. 4. Drainage will not be affected and is not a major consideration in our design. 5. Protective well radius will be maintained for all adjacent properties. The existing septic tank is corroded and needs to be replaced. Drainage will not be affected, and is not a consideration in our design. This work will not affect the reserve area on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RIVE GINEERING SERVICES Christopher R. Wood, P.E. Principal \2003\04-066SEencNARRAT[vE NO WELLS + 200' O' UTILIN M L194.00, N63'42'34 -W Ng1'00'17,W CONTRACTOR TO VERIFY 96.06' NEIGHBORING WELLS +100' - EASEMENT • - MONITOR TUBE SEPTICS +30' ------ - PROPOSED LEACH FIELD - SEWER CLEAN OUT - EXISTING LEACH FIELD ® WEST HOLE ®LL - DRIVEWAY _ 1. NO 'KNOWN CURTAIN DRAINS WELL SEPTIC SITE PLAN �...•�F q��h LEGAL: MAJESTIC VALLEY ESTATES SUB. LOT 3 BLOCK 4 " �� q 4/ OWNER: TOM DAWSON `P . S,f Itt CONTRACTOR: FLINSTONE ENT. or * 9 JOB 04-066 DATE: 7/26/04 SCALE 1 " . =40' /...� EAGLE RIVER ENGINEERING SERVICES CHRISTOPHER R. �s tt�% '. CE -10387 P.O. Box 773294 tt 4;" (90) 694— 5195 FAX.S(907) 694-3297 +, � ',;Vol N5621:4$1 IMPERIAL DRIVE L=123.86 45.00 / N76'21 10 W SCA E cpp•' •. 1 _ D' WELL .. 4 'O .: ° ' ' I INSTALL 2 AFTER NOVSE I TANK C.O.'S 5' 6' O V% N N /REPLACE EXISTING TANK W/ \ 100' WELL RADIUS � / NEW 1,000 GAL SEPTIC LJ TANK. BURY OLD TANK ON g SITE. =Lu NEO y N 0 CV to M Z NO WELLS + 200' O' UTILIN M L194.00, N63'42'34 -W Ng1'00'17,W CONTRACTOR TO VERIFY 96.06' NEIGHBORING WELLS +100' - EASEMENT • - MONITOR TUBE SEPTICS +30' ------ - PROPOSED LEACH FIELD - SEWER CLEAN OUT - EXISTING LEACH FIELD ® WEST HOLE ®LL - DRIVEWAY _ 1. NO 'KNOWN CURTAIN DRAINS WELL SEPTIC SITE PLAN �...•�F q��h LEGAL: MAJESTIC VALLEY ESTATES SUB. LOT 3 BLOCK 4 " �� q 4/ OWNER: TOM DAWSON `P . S,f Itt CONTRACTOR: FLINSTONE ENT. or * 9 JOB 04-066 DATE: 7/26/04 SCALE 1 " . =40' /...� EAGLE RIVER ENGINEERING SERVICES CHRISTOPHER R. �s tt�% '. CE -10387 P.O. Box 773294 tt 4;" (90) 694— 5195 FAX.S(907) 694-3297 +, � ',;Vol 0UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME —TP–HONE ®NEW �J �) r N/a/�L-C; !" /`C �i�7�VY l�,t ✓G .L n>�7i= /./ G�>C�'..'_s f(' ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION c•'f i', /mss/'--. 4, LOCATION _ ., NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. fJ DISTANCE TO: f� Lf .7 — Jr s'• / ,S' F- z CL Manufacturer Material No. of compartments ti N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth O Y DISTANCE TO: Well Dwelling PERMIT NO. J U) Z 024 T Manufacturer Material Liquid capacity in gallons Q w= DISTANCE TO: Well / Foundation Nearest lot line PERMIT NO. J LL z No. of line$ Length of each line Total length Trench Distance ' of Ines width between lines P ? [YPE OF SOIL HBSORBT1ON SYSTEM IS: TREHCH MRXIMUM NUMBER OF BEDROUMS SOlL RHTIHG (SQ FT/BR) 125 ^' ^ THE REQUIRED SIZE OF THF SOIL RBSORPTIOTA SYST&M IS: ' 17, TH 02" " I`h 1 - : "'`�U PK 541 F� 1F I, - 1";-- - ��, -,!� :)� Q 1! 1 two 07 1 ` FAK ?"s H.= P - THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF lTE TRENCH OR DRH\NFlELD. THEDEPTH OF H TRENCH 0R PIT I5 THE DIS|'RNCE THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTI0H (IM FEET). T|fE�� IS NO SET WIDTH FOR T�ENCHES THE GRRYEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL P111- AND IPERND OF THE (IN FEET), 114 PE kip It ,VX 0 0 K III, ���, -11- 1: Q W not Rh 4 I< YON X � �r, -,P �� ����:!! �_.4 '',��� PERMlT HPP|ICONT HHS THE R£SPONSIBILITY TO INFURM THIS DEP0ITMENl DURING THE INSTHLLITT ON INSPECTION5 OF HNY WELLS HDJHCEHT TO THIS PROPERTY HND THE MUMBER OF RESIDEsCES THHT THE HWL WILL SERVE N P AN n < Z& 7; X 5 1. 111 NZ 4 RE 17 - I X &A F45 ST 5- 1 !"! MR: Gs 17 G 1 It j Z F I K�E g n BHCKFILLING OF MAY SYSTEM WITHOUT FINAL I14SPECTI041 HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PRUSEC11TIUN, Q K O'k: N -,--I 1 , �� '", W: �I � BE vo H TRY P27 !?: :: :-�- U�U."! I CERTIFY TUHT 1� I HM F8MILIF91 WITH THE REQUIREMENTS FOR OH~SITE SEWERS 80D NELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2: l WILL INSTALL THE SYSTEM lN RCCORDRNCE WITH lHE CODES �� I UNDERSTRND THOT THE ON~SITE SEUR SYSlEI LOW REQUIRE ENLHRGEMENT IF THE RESIDENC l MORE 7UHN ] BFDR0OMS. H YELGPMENT �� 90, Davis St., Eagle River, Alaska 99577 "694-2774 or 688.2280 Russell Oyster Earl Ellis 6942774 SOIL LOG 688.2280 Soils & Foundations -- Land Development Performed for: PJame; c , . ± :': ; i-c;z.aar ..,1„ �, ., ,;,�; ; TO . No. 3 S_ :.... Flailing Address: Gox 353 ..; .77 ; >>. J > , J11.ska 99577 Legal Description'3,- Depth (feet) Soil CharacteristiS 0 :JT •- J:Ll �; ' on1 3OI_1 i4S.t 11 .3 21.n' -J 0?'7fl::a-''tSe 275 s io 1 2 3 4 5 6— Gr — a^ay '.i Y'9.`!31 with oo'o Qla3 to 18 Inches. VorY 7 angl-o.-II'. .: ]-i -ht +:rii--,a3 O , riltS -i i'-IDJOII1 hay, yrs. so. ft. /'o3r. 8 I 10 11---- 12 1____.._. 12 13 .a �Ltogs (1��'w.•M.. o.OpAlp,�ryp Ar N 1A.qqy. ;N 14 din y o ` 16 3C tl,odt Of pi4',. ps........e... f•...;......... m=, Earl P. Ellis NO. 1745-E Ground Water Encountered: YesNo If yes, what depth �a49NPr?0FEas�oNP Proposed Installation: Seepage Pit_ Drain Field Comments: Performed by: Date:M A w w A m a W • Y 4t® Q Y a A N � a V a a Q 3 l a 2 U A d W >a Cd7 O A w O O F F F X m F F w w U F F F LL LL E , FF 6 F F m a A w w A W w J w d A E., d x 3 l l l A d vFi A Cd7 O A w w A w w J w d A E., x w l l l O O O O O O O O O F F F F F F F F F F F F w w w w w O O O O O O O O O O O O F F F F F F F F F F F F E , FF F F w w w w w w w w w w w w °� a a a °� °a °� a w w w w w w w w w w w w w w w w w w w�� w w w 0 o O o 0 0 0 0 0 0 0 0 F F F F F F F F F F F F w w w w w w w w w w w w O F w 0 0 0 0 0 0 0 0 0 0 0 0 0 w w w w w wwwww Q w w y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H87-0158 264-4744 Application Date — 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3 Block 4 Majestic Valley Estates Subdivision - T14N R1W Section 23 Location (address or directions) Imperial Drive (b) Property Owner Jackie Allen Telephone: Home 349-5539 Business Mailing Address 3830 Coventry Drive, Anchorage 99507 (c) Lending Institution Lomas & Nettleton Telephone Mailing Address 4449 Business Park Boulevard, Anchorage 99503 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ®, if hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road, #204 Eaqle River, 99577 2. TYPE OF RESIDENCE Single -Family Elx Number of Bedrooms three ( 3 3. WATER SUPPLY Individual Well Ekx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite (Rx 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 (Rev 8/861 Front NOee 198/9 nam SzO-?L 3 to Z abed -NAom S,Jaaul6ua leuolssolwcl aql ul suolss!wo ao saoaaa aol alglsuodseA lou sl a6eaogouy to Al!ledmiunA aql panssl sl aleollphao e wolaq elep az (leue jo suopoadsul lonpuoo lou op SHHQ to saaAoldw3 sluawaalnbei alels pue leaapa} ulelm Als!les of aapio ul suollnl!lsul bulpual Alagl pue sawoq to siase4oind of (sal.inoo a se slgl saop SHHo aql e>lsely to alelS ag1 u1 paaals16aa aaaulbua leuolssaloid luapuadapul ue Aq anoge 9 4dea6e.4ed u1 uanlb suopeluasa.idw aql uodn Aluo paseq saleollpuao leAoaddy Al!aoglny U1leaH sanss! (SHHQ) saolAaaS uewnH Pue 4lleaH to luawliedeo abeao4ouy to AillecipunA a41 NOIIf1VO '! q frPoii Wfly leuolllpuoo lenoaddy leuolllpuoO to swial panoaddeslo XXY.XXXXX Panoaddy L 8 6 T T TTn.0 alep(q swooaPaq £ aaau-4 aol Panoaddy ` IVAOHddV SHHQ '9 •panoadda Mou sT PUP spaepue-s TpdTDTunY1 g4Tm sgaaui Agaadoad goG[gns aqj •aeauibua at;q IqpagaTduioo uaaq spq uozgoadsuT UP PUP pauszTdui000P uaaq aApq suoTgoaaaoo aqj 'L86T `ZZ gDJPI 3o TPAoaddV TPuoigzpuoD aug buzpaPbaa aaauzbua au4 uioaJ uozgPucazguoo uaggTaM paAzaoaa spq quauiq.apdap szus POS s,a9aul6u3 oleo LL966 aaAzg aT pg VoZ# p>?og ooZ aaATE GTbeg %COLT ssaappy 6 L 6 Z -t 6 9 - euogdalal uz Taauz ug -S)2 S wA!.J to aweN -uolloadsul s!4l to alep 941 uo loalla ul suollelnbei pue'saoueulpao 'sapoo elelS Pue ledlolunW Ile 41!m aouelldwoo u! sl Ovals is lesodslp aalemalsem ao/pue (lddns aalem alls-uo aqj 'uolloedsui pue uollebllsanul Aw wool pus sal!l aOeaogouy to ApiedlolunIN aql woal paumigo uollewiolui aqj uo paseq le41 A1!J9A aa4lunl I •ulaaaq paleolpul ainlonils to ad/l pue swooapaq to aagwnu aq1 aol alenbape pue leuo!lounl'ejes s! wags (s lesodslp aalemaisem ao/pue (lddns ialem al!s-uo a4l le4l smogs lenoaddy (l!aoglny WIeaH slgl to uo1le61ls8nul Aw 1e41 ApnA I 'molaq umo4s alep uopep!laA e41 to se pue ol9aa4 paxllle leas Aw (q pallppao sy NOIIVWHOdNI ONVVIVa'HOHV3S 3.113'SIS31'SNO11O3dSNl ONIaIAOHd WH13 ONIH33NION3 '9 1A; HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER& WATER INSPECTION ENGINEERING STUDIES AND REPORTS ROBERTA.SHAFER July 13, 1kOMICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Munk paP,i.-ty o4 Ancho Cage RECEIVED DepaiLtmewt oU Heaith and Human Seiwices 825 L Stneet Ancho,tage, Ataska 99501 REFERENCE: Lot 3; Mock 4; Majestic Va tey Estates CIVIL ENGINEER 694-2979 A eonditi.ona2 Health AuthoiLity Appnova2 was issued boll the Le6enenced pxopenty .in Manch, 1987. The conditi.o" o6 -this appnova2 Lequined a cleanout a4tek the septic tank to be Lepa.ined. Upon .inspection on July 13, 1987 .it .is determined that the cleanout has beenad� ety aepained. Request you pn.ov,ide. a 4inaL HAA at .this time. WELL INSPECTION & FLOW TEST / C� R RT A. SHAFER, P.E.�� RAS/ss SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 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� (i_% 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name' Ti Applicant Addres ��30 (c) Applicant is (check one): Lending Institution ❑ (d) Lending Institution Address e (e) 3 y9'SS� Business so er W; Buyer ❑ ; Other ❑ (explain); Real Estate Company and Agent 2z 6,2-t� Address Telephone Mail the HAA to the following address: 5& S ENGINEERING 0 1 f l I I i 17034 Engle KLYOr No. 204 uVIa Rlyfa", Alaska 99577 2. TYPE OF RESIDENCE Single -Family, Multi -Family ❑ Other Number of Bedrooms & 3. WATER SUPPLY Individual Well, Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteo 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 72-025nl,e4 5. ENGINEERING FIRM PROVIDIK NSPECTIONS, TESTS, FILE SEARCH, Di 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 this inspection. Name of Firm Telephone S & S ENGINEERING Road No. 204 - . ag OAlwska 99577 Address Date CLE�t`I bV l AF?e7L 5�T7L %r4nik 7g ScPAzAj�7� For 4 �oz�wv79G QiPG JZC�or4/2 rn2 h7GPz-isc& CcdYi-t,-oL-�i. woizk 7-b a,--1 % �0 ) I J 8 _:� A1,, " gi �. 45-4 6. DHEP APPROVAL Approved for bedrooms by bate 3-2 7`?7 Approved Disapproved Conditional X Terms of Conditional Approval 14 90 L-1 /'1E4L7-I0A1FQ COAND17-1041 TfE 6011PI- Fal) of TUNE f4 M87 dhep CAUTION r 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 72-025 (11/84) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HE #MJTHORITY APPROVAL (HAA) MUNICIPALITY Of A EPIVIROWENTAI SERVICE OR�S264- 720 VARY 1984 Legal Description: / moi` -3�'< <� MAR 2 31987 R'EC'EIVED Well Classification �• If A, B, C, D.E.C. Approved (YIN) N/A Well Log Present ©N) Date Completed (0-Z- 7_' Yield !V_'0�3 &^4 + Total Depth /7/ Cased to % W Depth of Grouting Static Water Level Zg5-1 Pump Set At U X Casing Height Above Ground — Electrical Wiring in Conduit (9/N) Separation Distances from Well: o« Sanitary Seal on Casing 61\1) Depression Around Wellhead (Y/I To Septic/Holding Tank on Lot 114 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /�� On Adjoining Lots To Nearest Public Sewer Line !\r�A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot S /'4 Water Sample Collected by d `� L>`L idCzakuVDate 3 11S�f3� Water Sample Test Results SNZ-V-t 5i�flc Pow Y Comments B. SEPTIC/HOLDING TANK DATA Date Installed (2-5—'70 Size /Cxao No. of Compartments Z StandpipesY)N) Air -tight Caps (YIN) Foundation Cleanout (ON) Depression over Tank (Y/bb) / Date Last Pumped 3 - / Pumping/Maintenance Contract on File (YIN) �r ; for &IIA Holding Tank High -Water Alarm (YIN) "114 Temporary Holding Tank Permit (YIN) N Separation Distances from Septic/Holding Tank: To Water -Supply Well InD7f S / To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Building Foundation 0/_/' To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils RatingAbsorption Strata Z 5 �2 � in p Type of System Design IizGnlCfi Date Installed Length of Field Width of Field 4102 Depth of Field. Gravel Bed Thickness Square Feet of Absorption Area L% y�� Standpipes Present(;�YN) Depression over Field (Y,P Date of Last Adequacy Test 3 -I Results of Last Adequacy Test SAr�sR42v�YZy F -!*-3 8k Separation Distance from Absorption Field: To Water -Supply Well /<.::,U `4 To Building Foundation Lot ^`(A To Water Main/Service Line /aY� To Stream/Pond/Lake/or Major Drainage Course To Property Line 6b i_/ To Existing or Abandoned System on On Adjoining Lots 3b To Cutbank (if present) N14 I!/A To Driveway, Parking Area, or Vehicle Storage Area /a6' Comments .5ee4,ZN7CZ> F/ZO.4 d%,v ,771- 7 D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at ;High Water Alarm Level at Vent (Y/N) i Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments '" Check Permitted Bedroom Rating Against HAA Request " I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sigs&S ENGINEERING Date r�7034 Eagle River Loop Road. 2 Co Eapankiv.r;�ciorke99577 MOA No.�Ss����� Receipt No. /V O /, 6 3 Date of Payment _Y/2 7�2- Amount: $ Page 2 of 2 72-026 (11/84) OF -� ao•o 0Cn6Nn on n ono td®. 1M74 n; 7 " 00 1u QV 09a PonOW=A6 �C'. v �} C� e0T L — c6 M NICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT OI I EALIi 1 c. \� 825 1. Street - Anchorage, Alaska 99501 ENVIRONMEN I Ai. ;' C TECTION ENVIRONMENTAL ENGINEERING DIVISION rye: p 1 8 '198l Telephone 2414.4720 SINGLE FAMILY FIE -QUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE:FW111A. p DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Pleaseallowton (10) days for processing. 1. PROPERTY OWNER AVID A ll DE60eA H K. ,DeA IM IX(Three C] Six r 69 •3676 nnriluNc-Aoon�s� �s 17Z 9 CA6L. 21 V EP ,eoA zD E -AGILE k2i_VEte, Ak.-99577 PROPERTY RESIDENT OF difforent11-0N[--'--- depth (attach log if available.) 2. BUYER - PU((�I _ --- -- 0 If system is over two (2) years old an adequacy test is required ---------��------ MAILING ADDRESS — — 590 MC(6c) Dfz _ RNCOO2A E�4K�� a� d. LENDING INSTITUTION PHONE ALASKA M.u-1`14AL, 13A))e- 1694-9571 MAILING ADDRESS (001 W, art AV67 ANCRO(ZA6E - _'-- 4. REALTOR/AGENT - - - - /V o - - PHO E MAILING ADDRESS 5. LEGAL DESCRIPTIONLOT 3 (3 i QC K `M fJTC.s l f C VA LL( `1 E-:5'TSS S V STREET LOCATION -- — - — A---- —_— ��_ IMpEt2/A-L Die/VE MI 6;S- t5AGtE R(ve-ooe 2D 6. TYPE OF RESIDENCENUMBEROF BcDROOMS — SINGLE FAMILY 17-1 One - f;J Four 0 Other - - E Two. C3 Five ❑ MULTIPLE_ FAMILY IX(Three C] Six 7. 1 1 INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled C] COMMUNITY since June 1975. For wells drilled prior to that date, give well L PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - 1% INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date_ 0 If system is over two (2) years old an adequacy test is required PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, ISUE • a) OLO-ZL - - NOIldla_O_S:id lV`J_3� l — ollll) All w- - 31V0 _ aaAOUddVSla (aieal;hja Aueclw000e isnw Jaiial) -IVAOIiddV-IVNOIJ. ICJNOD SINOOHCI36 �— HO -A 03AOHdd ,,fp - S.LN3WWOJ 'S . __ _----_--- --- -- - aui1103 Isamau o1 eajV uopda��sgv Ol 1-131A Bull 10-11SSIBON aui-1 aornaS ,,V u011d�,SIJV lue-Lfu.pinH/.illdaS SaaNVlSM '17 - "1VIu3.LVW V3HV N011dH0S9V'IV101 - wunlJVJnNVW - NNVl J0 3dA1 — ------- :S1.101SUOullp anlu -- --- 9WIVH S`110S epewawet{ Sl JUel 11-0-00% :0ZIS --- ^ duel 6u!PIOH ❑ JO duel alidoS❑ palilaaA u0tl0[tuu00 L — A1nun oriand❑ as„V_1SNi JiVa 3115- NoilvnalAlaNI O a39wnN llwHad W31SAS-IVSOdSlCI 3JtlM3S T - 03/U3C73H 00-1 �PIP .IM 1101iaauuo0 - A1n11n a1 -]end ❑ ❑31llHa 31VO A.LiNnNtlYW) E-1 113M JO H1d30 IVnalAlaNI ❑ A IddnS 1131dM .z a39WnN.I.IALIJd XIS [] NnOd ❑ OM1. ❑ llWtld 3ldllinw ❑ Ii3H10 C7 3AH ❑ 338FI1 [] 3NO ❑ A-IIAV3 3l9NIS [.7 3ONMISEW 40 AdAl I �SNOIJ.�3lII❑ HOlO3dSM }J0103dSNl a01O3dSNl 3J.'da _ 31VO _ _ _ 3.LV0 _—s _. 3WIJ. -----...---_T_--- - :7_WIl_ SJ-N3W.LNIOddV N01103dSNl ' O3nl3O311 31V0 f AINO 3Sn lt/lold30 Hoo 3OIS SIH.L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 CStreet - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all its on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. - 1. PRPERTYOWNEF� PHONE h MA(�1 NG ADDRESS �% F(3 PROPERTY RESIDENT (if different from bove) PHONE 2.P S M- - PHONE HONE MAILING ADDRESS 3. L DING INSTITUTIO l , 7—PHONE MAILING ADDRESS— 4. REALTOR/AGENT —ONE MAILING ADDRESS L GADESCRIPTION--1 STREET LOCATION 1 ]- 6. TAPE OFF RESIDENCE NUMBER OF BEDR OM �L(J SINGLE FAMILY ❑ One ❑ Four ❑ Ot er ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ 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.) 8. SEWAGE DISPOSAL SYSTEM \L] INDIVIDUAL/ON-SITE** **lf individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. /L -V IV 01 /0/ THIS SIDE FOR OFFICIAL USE ONL INSPECTION APPOINTMENTS DATE RECEIVED ` TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE CY SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY Lam' INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER C41 DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPO SYSTEM CI-I'I`SDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER eptic Tank or❑ Holding Tank Size: 1040 If Tank is homemade give dimensions:, SOILS RATING TYPE O FkMK J ` MANUFACTU, J3ER J TOTAL u/ pSSORPTION AREA MATERIALetl 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. Fg/APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE /a/ 7(6" BY (Title) _ LEGAL DESIDRIPTION 72-010 (Rev. 3/78)