HomeMy WebLinkAboutMOUNTAIN MANOR BLK 2 LT 5Mountain
Manor
Block 2
Lot 5
#050-671-16
Municipality of Anchorage Page of
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: .S h/ 92194,74 PID Number: OSb-!o7/ - &
Name:
Wastewater System: ❑ New Upgrade
T�/2/ZfC/VCF, ODD
Address:
471a m DX- /�/cH 99 D
ABSORPTION FIELD
Phone:
- 9
No. of Bedrooms:
1 3
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Q'
Total Depth from original grade:
GPD/Sq. Ft.
O r •x
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
5 Z M DUN
/-3 Ft.
7 Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
59
D_ Ft.
Ft.
WELL: /6f//q43 New ❑ Upgrade
Gravel depth: W/OTN
Number of lines:
Distance between lines:
5y
13 Fl.
Classification (Private, A,B,C):
IP4/Q�E
Total De
Ft.
Cased To:
Ft.
Total absorption area:
`. +750 So. Ft.
Pipe material:
3034 4
Driller:
Date Drilled:
Static Water Level:Inst
Iter:
l
Date Inst lied:
9 ZZ
Ft.
llASMUS o
Yield:
Pump Set at:
Cesing Height Above Ground:
6X15-flV TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Peptic ❑ Holding ❑ S.T.E.P.
To
06 tic N
on
Absorption
Holding
rIvate
Manufacturer:
S
Capacity In gallons:
/ 2 50
From
l
Station
old
014.5 ET
Well
N14
9/4
r"a,_'
Material:
/l3eR61- A
Number of Compartments:
Surface
/Y14
NlA
/IIIA
NIA
NiA
LIFT STATION
ne
/
t8o'
NI,a
N/.�
+/o �
Size in gallons:
Manufacturer:
/DD
Foundation
A
'Pump on" level at
p oft" level at:
High water alarm et:
/
r'
NI
NIA
Curtain
A, A
4
�/ A
4,Y
±1JV14
A/
/�
Pump Make el
Electrical Inspections performed by:
Drain
Ir
Remarks: Exist -1 /0-�/e/ ,-e_A*
BENCH MARK
Location and Description:
D IUCY,C'tn•v (/R /I/C /Nstr•//L'c! y
Tv vt /4ower c(..+c JJep
Assumed Elevation:
Ft
ENGINEER'S SEAL
Inspections performed by: Dates: 1st 2
2nd -D_2/22%92
Department Health ay. Humn ekyices approval
of
Reviewed and approved by: '' Date:
72-013 (1/91) MOA 26
Permit No. SW 920274 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Mountain Manor, Lot 5, Block 2 PID No.- 050-671-16
LOT 6
leo N 84°010- W
45.66
too• / Psf' ��� \ _ / / WELL
u ti % ti PVA
A HOUSE
i✓,p J C EXISTIN _B
diversion 1250 GAL. W
vD ve TANK
iQ existing trench
� . r)
/ _ a O
In U
/ Z
APROX, SLOPE EDGE LOCATION
SCALE 1"=60' LOT 5
® - TEST HOLE
• MONITOR TUBE
0 - SEWER CLEANOUT
+1+111++111 - EACHFIELD N 8010,0 w
- EASEMENT
SWING TIES ST ILLVATER DRIVE 60'
A - C = 14'
B - C = 38.9'
A — D = 47,6' NO WELLS +100'
B - D = 83.5'
',. ENQINEER'S'SEAL
ELE U ATIONST�OF CONCRETE BOTTOM STEP OF BACK DECK a '
(NOT'. TO SCALE) V ITEELEV - 100.00'
0 2' ADDED PILL
ORIGINAL O r f'
ORIGINAL
GROUND
+3.0' LEVEL B
1
CXISTIN89.9'G NO GVT ENCOUNTERED
TANK B99' V
- 75 B'
NOT UNCOVERED FIELD [
FOR LEVELS
n
12-01J A (Z/91) MOA 26
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE `-lr(n
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920274 DATE ISSUED: 9/09/92
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 9/09/93
OWNER NAME:WOODS TERRENCE L &
OWNER ADDRESS:4710 SPORTSMAN DR.
ANCHORAGE, ALASKA 99502
PARCEL ID:05067116
LEGAL DESCRIPTION: MOUNTAIN MANOR BLK 2 LT 5
LOT SIZE: 48389 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED E
ISSUED BY;
�y
DATE:
DATE:
�� �' q2
Louis Butera, P.E.
Registered Civil Engineer
August 31, 1992
John Smith, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Mountain Manor, Lot 5, Block 2
Narrative
Dear Mr. Smith:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The area has large lots allowing sufficient room for septic sites. This is the
second site on this lot in 15 years.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate. The old leachfield will be retained for future usage.
4. Drainage will not be effected and is not a major consideration in our design.
The leachfield for this home will have to be constructed on 40% slope as there is no other
available area. The existing system is constructed on approximately the same slope, and is a
trench of similar construction with no problems experienced in 15 years of operation. The slope
is well vegetated and has small spruce trees to the edge of the lot at Stillwater Drive, and there
is sufficient trench length to allow effluent dispersal. It is our professional opinion that
construction of the leachfield on this slope in these soil conditions will not create a condition
where effluent is exiting the slope surface or causing an unstable slope condition.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694.5195 • Fax (907) 694-3297
/
/
/
/
LOT 6
laa'
/ PSS
100'
Z15•X
5' WIDE TRENCH
.10
EXISTING
dwersion o 1250 GAL.
alve TANK
N 84`010' W
45 t�'r,
W LL
\ HOUSE 10011
L❑T 5
STILLWATER DRIVE
60,
NO WELLS +100'
NTH �\++H+H+w
trench
o
P
APROX. SLOPE EDGE LOCATION
® - TEST HOLE
• - MONITOR TUBE
0 - SEWER CLEANOUT
¢ - WELL
H+ - PROPOSED LEACHFIELD
NO KNOWN CURTAIN DRAINS — EASEMENT
SEPTIC SlITE PLAIN
LEGAL: MOUNTAIN MANOR LOT5 BLK4
OWNER: TERRENCE WOODS
CONTRACTOR: N/A
JOB # 92-128 DATE: 08/27/92 SCALE 1" = 50'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 5, BLOCK 2, MOUNTAIN MANOR
A. GENERAL
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified or modified in the
field by the contractor to meet Municipality of Anchorage, Department of
Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 10' from ground surface.
4. The sewer line is to connect to a diversion valve to allow effluent switching
between the existing sewer line that leads to the existing trench.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 10' GRAVEL DEPTH = 7'
TRENCH LENGTH = 54' TRENCH WIDTH = 3'
SOIL RATING = 0.6 GPD/FT2 BEDROOM CAPACITY = 3
SEPTIC TANK SIZE = 1,250 GALLONS existing
Twenty-four (24) hours notice required for all inspections.
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
JOB Mountain Manor Lot 5, Blk 2 92-128
SHEET NO - --— — OP--- /
CALCULATED BY —_-_._ L.B. DATE
CHECKED BY ._— DATE _.__.SCALE ---
Single Family Three Bedroom Residence
3 Bedroom = 450 GPD
Soil rating = 0.6'GPD/ft2
Absorption area required = 450 0.6 750 square feet
Trench dimensions (absorption area 1,020 square feet)
Width = 3I'
Length = 54'
Gravel depth = 7'
t '
' t
C.
PRODUCT204-1/ens Inc, Wtw, Mass. O1471.
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 7e✓r7 DATE PERFORMED:
LEGAL DESCRIPTION:
^ _ l�fJr ��y Z Township, Range, Section: T/y„/ 2 !w s;Pc 6
D, PT -fes SLOPE SITE PLAN
1
. C7 --
2 0
3
o.
4 or
' o
5
r
6 v
7 0
8 p
ti
9
10
O,
11
U .
12
13 0
14
S4N�y li-r�vl-1 C✓/fI�/
r.L
Si/f %✓7�N�"
Uer re Cook WAS GROUND WATER
ENCOUNTERED? /yy
>a /i
18-
19-
20-
COMMENTS
81920COMMENTS
s
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water Alter ,
Monitoring? t /� Date: 151,7119
e
d'
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
SoA �
7w,
la
PERCOLATION RATE 16 (minutes/inch) PERC HOLE DIAMETER 6 '
TEST RUN BETWEEN % FT AND FT
PERFORMED BY: 4--2 IF f I C ERIIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
'°UNJCIPALITY OF ANCHORAGE
Hea, and Environmental, PrOteCL Al
Fourth Floor West
825 1, Street
Anchorage, Alaska 99501,
279-251-1, x 224, 225
INSPECTION REPORT ON-SITE SEWACE DISPOSAL SYS'WA
LOCATION.. ION L MP.w
SEPTIC TANK:
DISTANCE I
'E�
j NUMBEk OF
COM PA I � I M L N I S
_1
FROM WELL., MANUt /11( 10HE k
4 1
INSIDE L.ENc; ri i N',Wt. W11, I H
tQtIllj
PLPIH 101)10 CA A I I y G A L L 0 IA'
TILE DRAIN
f
T
I 1 0 Tb I __ U-NGTI
I
00 4 - 1
DIST '�NCL f ROM WILLL - _OIJ"WAII0N
35 rqf
AfUtl ICA LII\Jf- 0 i L :N1_
36 IN.
U F EC I 1\/�
# of Lines - .I__.___" L)ISJ;tNC1_ 1A I N,LLN
1,
WII)T;I TOTAL
AP�f;OHPTION AHEA . q7o 1 1,
1 1 NG rI 1 01'
PCI I L INi
UL_PT 11 OF
1 ILTER
DEPHi: 101- 01 TILE. I[J' 1 f INiSH GRAi)l
MAI U R I 11\1
(U.NFAIII TILE ABOVE IIIJ
SLEPAGE PIT;
1X%rAE1EP
WInfli
I DI -Pill
Log Crib Rings Crib Size:
_01STANCE F!!OI`v1:
I ()I AL E FFECI IV[.
BUILDING FOUNDATION __— ._ . NEA I j r-', I L 0 T
1, 1N!
fdI',0 RPT ION AREA (WAI-1- ARE Ay
Well
Class:
Depth:
Well DTstance To: Lot Line
Bldg: )c)4 Sewer Line:
Pipe Materials: 0,
# of Bedrooms
Installer:
Remarks:
'7
1 1
nl� 4'rf T-
I I t
Ok" W;YA
25%7/?AFlp R Ov I ------
4 1
T
Ok" W;YA
25%7/?AFlp R Ov I ------
4 1
Ok" W;YA
25%7/?AFlp R Ov I ------
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
THE LENQTH DIMENSION IS THE LENGTH (.IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE QF THE
GROUND HN[ THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCHVATION (IN FEET).
1. 1 C'. -V" VA �I Z' FE. fl. �(7-1 C-4 �" I .. .... ('.."J P-4 *."_3
�" I _ vz"" C-3- F;�: F=M �" P-4 -7- ���Ir Cj P-4
H PHC<HGE PLFINT MAY BE INSTALLED HT THE PERMITTEE -"S OPTION SUBJECT TO THE
FOL1 8WING CQNDITIONS:
1. EITHER H Cl -HSS I OR II MSF APPROVED PLANT MAY BE INSTALLED.
2. H CONTINU8US MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQ0IRED TO ENLHRGE THE SOIL
ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION.
I r -A n3 F"FE C -r IF C -I r4fF. F."IE F? t.-7-. C".,! (J 1 Fe. F.H., F>
BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTIQN HND APPROVAL. BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL HND ANY 8N -SITE SEWAGE DISPOSAL. SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL.
WELL LOGS ARE REQUIRED ANI) MUST BE RETQRNED TO THE DEPARTMENT WITHIN ]Cl DHYS
OF THE WELL COMPLETION.
OTHER REQWIREMENTS MHY APPLY. SPECIFICATIONS HND CONSTRUCTION DIAGRAMS ARE'
HVHILABLE T8 INSURE PROPER INSTALLATION.
�FEE ����IFE Fe.
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN HCC8R1-*,HNCE WITH THE C8DES.
]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLFIR GEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE "THAN ] BEDROOMS.
SIGNED //oz
.
ISSUED BY��. ��~~~ V]0
x.9k_9o=X �����A. " 'r r," �����,F-D 5"�1-1 R_1 r_...
.
DEPARTMENT |
lEHLTH HND ENVIRONMENTAL TECTION
825 'L�
�TREET, ANCHORAGE, HK 995�� `
�
279-2511 »'
���� ����
��~���� ����� ������
\\���q(�
PERMIT
NO.
APPLICANT
MC L.EOD CONST
PO. BX. 795 E�R�
694 9715 `
LOCHTION
-R.--~
LEGAL
LT. 5 BK. 2 ��MHNOR
v
LOT SIZE 48]89
SQUHRE FEET
TYPE OF SOIL HBSORBTION SYSTEM TRENCH
MAXIMUM NUMBER
OF BEDROOMS =
] SOIL RATING (SQ FT/BR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
THE LENQTH DIMENSION IS THE LENGTH (.IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE QF THE
GROUND HN[ THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCHVATION (IN FEET).
1. 1 C'. -V" VA �I Z' FE. fl. �(7-1 C-4 �" I .. .... ('.."J P-4 *."_3
�" I _ vz"" C-3- F;�: F=M �" P-4 -7- ���Ir Cj P-4
H PHC<HGE PLFINT MAY BE INSTALLED HT THE PERMITTEE -"S OPTION SUBJECT TO THE
FOL1 8WING CQNDITIONS:
1. EITHER H Cl -HSS I OR II MSF APPROVED PLANT MAY BE INSTALLED.
2. H CONTINU8US MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQ0IRED TO ENLHRGE THE SOIL
ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION.
I r -A n3 F"FE C -r IF C -I r4fF. F."IE F? t.-7-. C".,! (J 1 Fe. F.H., F>
BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTIQN HND APPROVAL. BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL HND ANY 8N -SITE SEWAGE DISPOSAL. SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL.
WELL LOGS ARE REQUIRED ANI) MUST BE RETQRNED TO THE DEPARTMENT WITHIN ]Cl DHYS
OF THE WELL COMPLETION.
OTHER REQWIREMENTS MHY APPLY. SPECIFICATIONS HND CONSTRUCTION DIAGRAMS ARE'
HVHILABLE T8 INSURE PROPER INSTALLATION.
�FEE ����IFE Fe.
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN HCC8R1-*,HNCE WITH THE C8DES.
]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLFIR GEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE "THAN ] BEDROOMS.
SIGNED //oz
.
ISSUED BY��. ��~~~ V]0
0 & E GEO v CHNI CAL Et DEVEL,, WENT CO.
Box 90, Davis St., Eaijlo [liver, Alaska 99577
694-2774 or 688-2280
Earl Ellis
Russefl OYSter 6W-2280
694-2774 SOIL LOG Land Development
Soils Et Foundations
Performed for: Name:
Tel No.
Mailing Address:
Legal Description:z X "All
Ue t h _feet Soil Characteristics
0-
5
6
�q
Ground Water Encountered: Yes__,_ No /.,_ If yes, what depth
proposed Installation: Seepage Pit__ Drain Field
Comments:
Performed by: Date:
This well is Producin42 gallons water Per hour. Set pum�` �fS iket.
INVOICE jNVO Z NO.
MOON DRILLING ��� � DATE
SR BOX 668, BOGARD RD. YOUR P. o. NUMBER
PALMER, ALASKA 99645C'L
TELEPHONE 745-4071 TERMS
n �l ��Q SALESMAN��
.� MIL, oL c.,W1k�(/ 1Wr/1/ L L �6��
®FORMATION
® FORMATION
201
��/Llrf/��202203
�1Y•�riif�
204
�Y■r�205
���✓i/iI�
s moi-
���5����TiY
�rY■Yw�►�Y■Y
�YYYYYYI■
YlY■■Y��-i■Y
���rYY�■�
w■r�,•�YY
_
YY■�.►�YY
YY�r�Y■Y�
■�Y�Y�� ■�Y�■�Y�
�r�■�■■
�i'MMAEC`- ���.�Y.
■�Y�Y�Y
� ���YYY
��Y■��
�YY�Y�■ ��Y��
� �Y��r•Y
iY■��Y�Y �Y��YY■Y
���■
�
�Y�. �Y��r.■��
■rY ■�rw�
wr.��� ■Y■�Y�
'rrr■
Y�w�� Y■�Yr■�Yi■
■�■Irt�
���
286
�wiirw•�ir:sia�
Yom■ 'L'I,���280�
.i0dE0PAWW- !NM
290
Yom■ . i � a rY�
�
• Municipality of Anchorage *A�
On-Site Water and Wastewater Program(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050 - C7/— IC Expiration Date: 2- 6 1
1. GENERAL INFORMATION
Complete legal description
Location (site address) /BK-OQ
RoaOIX e�
z5A
Current Property owner(s)
C aro f
r
6:70-44avw
Day phone 6%L ?% 03
Mailing address
Real Estate Agent J/✓Yt /vCice�l Day phone 350-Cgoof
2.TYPE OF DWELLING:
0 Single Family (w/wo ADU)
Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by. (� ) r L,
-COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ y' n
Date of Payment 11 I l
Receipt Number
COSA#
Date:
WaiverFee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation,
based on procedures outlined'in the. Certificate of Onsite Systems Approval Guidelines for this application,
Shows that the on-sitewater supply and/or wastewater disposal system is (are) safe, functional and adequate
for the:number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm 416rTkfein, t:,oF-,qPhone al, ?00
Address %� 776 7
Engineer's Printed Name _-Zz'TE✓E E,cfG' Date
6. DSD SIGNATURE
System #1 Approved for -3 bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By: Original Certificate Date: 1/ Z6 -
The Municipality of Anchorag evelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.d..
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: fi& L ,.a 41guar 62 L J5 Parcel ID:dSd -6 71-/6
A. WELL DATA
Well type T, If A, B, or C provide PWSID #
Date completed as //77 Sanitary seal (Y/N) �[
Total depth X78 ft. Cased to�ft.
Date of test
Static water level
FROM WELL LOG
_,g6//77
Well production
WATER SAMPLE RESULTS:
am
Coliform 2 colonies/100 mL Nitrate N6 ��mg1L
Arsenic:. � . ug/L date of sample:/ (7'L
B. SEPTICIHOLDING TANK DATA
Well Log (YM)
Wires properly protected (Y/N)
Casing height (above ground) _in.
AT INSPECTION
/00./
ft.
6 D g.p.m.
Other bacteria O colonies/100 mL
Collected by: Ar -
Tank Type/Matedai S Date installed
Tank size /Z SO gal. 'Number of Compartments Z Cieanouts (Y/N) Y
Foundation cleanout (YIN)* Depression over tank (Y/N) Al' Depression water alarm (Y/N)
Date of pumping - / zr Pumper
C. ABSORPTION FIELD DATA - /
Date installed 22 2 ,Soil rating (g.p.d./ftZ or ft2/bdrm)_ System type / r2n c
Length 9 ft. Width ft. Gravel below pipe 7 ft.
Total depth ft. Eff. absorption area Zfe Monitoring tube Depression over field __A_/
Date of adequacy test 712AZZ Z Results (Pass/Fail) Gxs For 3 bedrooms
Fluid depth in absorption field before test -5- in. Water addedC�gal. New depthZ0 in.
Elapsed Time: min. Final fluid depth _rj_ in. Absorption rate >= 4Zo g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)'' &4.(G If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" lev t _ in. °Pump ofP le at _ in. High water ala level at in.
Datum Cycles sted Meets al & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tanknift station on lot /00 %/-
Absorption field on lot %5
Public sewer main ZV'
/
Sewer /septic service line Z 5 t
Animal containment areas /00' 't
On adjacent lots
On adjacent lots
/Oz) -',e-
Public sewer manhole/cleanout 44
Holding tank ��ILA
Manurelanimal excrete storage areas /O
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 /f Property lined Absorption field S r t
Water main Water service line if Surfacewater AGO �t
Wells on adjacent lots Q
ABSORPTION FIELD ON LOT TO:
i
Property line_... /6 /t Building foundation AQ;" Watermain 44
r / el
Water Service line �S Surface water Driveway, parking/vehicle storage
Curtain drain I I Wells on adjacent lots /Grp 14
F. COMMENTS
?L*7� G. fo o e✓'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed NameS r �—`vF ENG
Date
COSA brown sheet 9-1-U.doc
fee" 5 z:
cot
Rd ° / 4
4�
'fit"
�� �'I
&�
tlf
ko
J
-if -a -v - c`/'��,�-y��-�-L'w
2JO,
AS -BUILT
I hereby certify that I have surveyed the following.
described property: 4 -o -t}_(._810 e
Hovn�f %% l t �4< Y
'S� r
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon we within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach on the premises in
question and that there are no roadways, transmission
lines or other visible easements on said property except
as indicated hereon.
Dated at Eagle River, Alaska
this -
day of 19
ROBERT C. JOHNSON r;,7:.:v-
SCALE: Registered Land Surveyor No. 860-L9
I'= 51s Box 456, Eagle River, Alaska
Phone 604-2543
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES y
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 050-671-16 ` /y HAA #
1. GENERAL INFORMATION
Complete legal description Mountain Manor, Lot 5, Block 2
Location (site address or directions)
18600 Roads End, Eagle River
Property owner Terrence Woods Day phone 762-7678
Mailing address
Lending agency
City Mortgage Day phone 277-0700
Mailing address P.0. Box 92810 Anchorage Ak 99509
Agent T)P�un 9, r Pc; rte,1 py Irenti1ry 71 Day phone 696-8600
Address 11901 Business Blvd., Eagle River, AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
X
0
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Eagle River Engineering Services Phone 694-5195
Address P.O. Box 773294, Eagle River, Ak 99577
Engineer's signature _— Date
6. DHHS SIGNATURE
Approved for
Disapproved.
By:
Conditional approval for
Additional Comments
bedrooms.
bedrooms, with the following stipulations:
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 k21
Municipality of Anchorage
Department of Health & Human Services "
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: PlouMiA/hJ /11/41vUk LOTS 16aZParcel I.D. 050- C9'7 / — / L
A. WELL DATA
Well type PRI VAI'i�_ If A, B, or C, attach ADEC letter. ADEC water system number &11A
Log present (Y/N) yE 5 Date completedDriller_ AlooN
Total depth Z %� / Cased to / cl 5 / Casing height Z& /
Sanitary seal (Y/N) Y65 Wires properly protected (Y/N) XC5
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
oyv)- I-id!ca ka( u,,J G;/S
g.p.m.
Z/D /
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
0?Zo* 9- ;a cn
r7) t7
/P. U rri
g.p.m. c.+
I�N�CNl�1NN < GO
N
Septic/he" tank on lot /�� � ; On adjacent lots
Absorption field on lot
; On adjacent lots
A
-,0-/00 /
Public sewer main &/A Public sewer manhole/cleanout /V 1A
Sewer service line + ;Z s / Petroleum tank
m
in c
oZ
D
7�yy. r
V-
A O
< Z
rn
N O
?' m
O
Z
WATER SAMPLE RESULTS:
Coliform Nitrate/ m Other bacteria
V/97-
Date of sample: 0 / D y/ 22�Z Collected by:
B. SEPTIC/HGLO MG TANK DATA
Date installed 0P/ 7 % Tank size Z Z 50 Compartments
Cleanouts (Y/N) \1 C5 Foundation cleanout (Y/N) Y6 Depression (Y/N)
High water alarm (Y/N) N 1 Alarm tested (Y/N) /-/ 1A
Date of pumping 0
Pumper ,7`Dc r
SEPARATION DISTANCES FROM SEPTIC/HQ4:G+d6 TANK TO:
Well(s) on lot //01 On adjacent lotsIoCL Foundation /2- 1
To property line /00 Absorption field /G'11 Waterrt=M/service line f" /O
Surface water/drainage &11A
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
Meets MOA electrical
"Pump on" level at
Manufacturer
Manhole/
SEPARATIO-NDTSTANCE FROM LIFT STATION TO:
7[.11
On adjacent lots
D. ABSORPTION FIELD DATA AJe,.J -,e 14 0A %A
"Pump off" level at
Cycles tested
Surface water _
Date installed 2 rte `i2 Soil rating OPD SFr Zsystem type 1;iuE cf4
Length Width .3 Gravel thickness 7 Total depth /0
Total absorption area,, t �5U n Cleanouts present (Y/N) Y6 5
Depression over field (Y/N) / Y C� Date of adequacy test N/A
Results (pass/fail) RA S for ,_!� bedrooms
Peroxide treatment (past 12 months) (Y/N) If yes, give date N/A
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot � / 00 / On adjacent lots -,- / Property line
To building foundation s5 To existing or abandoned system on lot
cfy.°�'rrr�r
On adjacent lots t 30 / Cutbank ^� Ip s ��° slol Water remai-n/service line_
Surface water A/ 11A
Curtain drain N,IA
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
tio)
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date „of this inspection.
,
Signature
Engineer's Name
Date o' Ay 2
HAA Fee $ /7() e620
Date of Payment !`- 2,3 ` �Z /7
Receipt Numbers
Waiver Fee: $
Date of Payment
Receipt Number
AUG 07 '92 10:04 NORTHERN' TESTING, ANCHORAGE
P.1/2
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE
2505 FAIRBANKS STREET
Eagle River Engineering
PO Box 773294
Eagle River KA 99577
Attn: Lou Butera
Our Lab 0:
Location/Project:
Your sample ID:
Sample Matrix:
Comments:
A119390
Mountain Manor 5/2
)Water
FAIRBANKS, ALASKA 99701 (907) 4563116 • FAX
ANCHORAGE, ALASKA 99503 (907) 277.8378 • FAX
Report Date: 08/07/92
Date Arrived: 08/05/92
Date Sampled: 08/04/92
Time sampled! 16.5
Collected By: MD
MAL = Method Detection
Limit
Flag Definitions
B - Below Regulatory M
H - Above Regulatory M
E = Below Detection Li.
Estimated Value
Method Parameter Units Result Flag MDL
r.Y ---------------- T.1 T11- ..WWW.....Y.
EPA 353.3 Nitrate -N mg/l 1.5 0.5
Reported By: SusanC. ifental
Microbiology Supervisor
-r
92
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 4/28/86.
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5, Block 2, Mountain Manor T14N R1W Sec. 6
Location (address or directions)
Roads End Circle
(b) Applicant Name Terry Wood Telephone: Home 694-9904 Business 279-7671
Applicant Address 7297 Skyli.ne Drive, Eagle River, AK 99577
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Alaska State Bank Telephone 277-5661 _
Address Anchorage, AK
(e) Real Estate Company and Agent N/A
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family ® Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well Q 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 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.
Pagel of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, 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 this inspection* with wavier of well—leachfield distance to 95'
Name of Firm
Address
Date
EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, AK 99577
Telephone
h, ..
^^ Sro«e Engineer's Seal
�f � �o-e ose omom: en oeopn�n ,n ':
1 v
Louis A. tsuicra
P:^^, CE -4736 , .Y
r0pSQ��
6. DHEP APPROVAL
Approved for bedrooms by ate
t.
Approved Disapproved _ Conditional
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
72-025 (11/04)
lawlm' .IrMfl l Vf ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOkl
HEALTH AUTHORITY APPROVAL (HAA) APR 2 9 'W
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: Gr3f������'u�,;tc" '
A. WELL DATA
Well Classification /"J i 4'<1 Tc If A, B, C, D.E.C. Approved (Y/N) ✓���
Well Log Present (Y/N) _Z Date Completed /o/ 7 7 Yield E G .ars i J i4 G(
Total Depth �2 78" Cased to ryo Depth of Grouting y'14
Static Water Level /05 ' Br/� . T�.� e4s s Pump Set At ZR
Casing Height Above Ground / Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) % Depression Around Wellhead (Y/N) N
Separation Distances from Well:
To Septic/Holding Tank on Lot !/0 ; On Adjoining Lots
To Nearest Edge of Absorption Field on LoOn Adjoining Lots 'X;a
Fr
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole IVA To Nearest Sewer Service Line on Lot
Water Sample Collected by 64c A !001 on !�x ; Date a-,/
Water Sample Test Results S4 f -is 7'�;- C 1dry
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed V77 Size --5 U� s / No. of Compartments
Standpipes (Y/N) %k Air -tight Caps (Y/N) !y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Al Date Last Pumped e_"�-
Pumping/Maintenance Contract on File (Y/N) �%�/��� ; for
Holding Tank High -Water Alarm (Y/N) 1114 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 1/4' To Building Foundation
To Property Line 1U0 To Disposal Field
To Water Main/Service Line
Course IVIA
Comments
Page 1 of 2
72-026(11/84)
id
i
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ✓c -'r Type of System Design Lee we- A
Date Installed ? Length of Field z1,7
Width of Field .36 /'
Depth of Field
Gravel Bed Thickness ,S`
Square Feet of Absorption Area Standpipes Present (Y/N)
Depression over Field (Y/N) Date of Last Adequacy Test
Results of Last Adequacy Test s / y dib s r d tea ms /C 3 Grp �tJ�
Separation Distance from Absorption Field:
To Water -Supply Well To Property Line
To Building Foundation To Existing or Abandoned System on
Lot IS114 ; On Adjoining Lots t2,) /
To Water Main/Service Line ���' To Cutbank (if present) 11,114
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area f io
Comments
D. LIFT STATION
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
** Check Permitted Bedroom Rating Against HAA Request **
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
�"`��11
Signed - Date te&j-/,:f �c
Company ✓ZL 1 MOA No.
Receipt No. 3Ra -:Y7 a
Date of Payment y- a R-%(.
Amount: $ (2 5 (4fp-
Page 2 of 2
72-026 (11/64)
Engineer's Seal
Oomo'��a�aaow
Pa000'6moo
Louis A. e.h ,.i o
o°o
Municipality
of
Anchorage
May 9, 1986
P.O. BGX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNO WLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Lou Butera, P.E.
Eagle River Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Subject: Lot 5 Block 2 Mountain Manor Subdivision
Waiver Request - WR86-054
Dear Mr. Butera:
0
Your waiver request for the subject lot has been granted. The required
well to leachfield separation distance has been waived to 95 feet.
This waiver is valid for the existing three bedroom single family
dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On—site Services
SSM/ljw
U
EAGLE RIVER ENGINEERING SERVICES
Lou Butera P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694-5195
Mr. Steve Morris
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, Alaska 995020650
Ref:Lot 5, Block 2, Mountain Manor
Dear Mr. Morris;
4/28/86
MGMoip
FHy,R�ePT��rY
y�>�MFHTA� °RpT �0.gGF
cF��F
O
On behalf of my client, Mr. Terry Woods, I am applying for
a wavier of well to septic tank horizontalseparationdistance
for the above referenced lot.
The septic system serving this lot was installed and inspect-
ed by the Municipality in 1977. The inspection report attached
indicates that the well is 100' from the septic leach field.
Our field measurements indicate a separation distance of 95'.
The well is 270' deep and draws from an aquifer at the 111114'
level. This aquifer is a bedrock aquifer, overlain by 15' of
bedrock. The topography of the lot is such that leachfield efflu-
ent is directed downhill away from the well location. It would
be safe to assume that the bedrock surface slopes steeply to
the south away from the well. The immediate subsurface soil
is rated GP (125) with layers of hardpan (GM) soil to the bedrock
surface. The well maintains a static level of 109' below the
land surface. A coliform water sample was taken and was satis-
factory. The area is one of low population density. A survey
plot plan is enclosed.
If there are any questions or concerns please call me at
my office 694-5195.
Sincerely,
Lou Butera P.E.
y.
Z:ate
PY
e or
4 -
Louis A. Cutera
CE 6736
2Zjol
AS-DUILT
rJrCZ PIA C
-7,: r L..L,
Aq C
I hereby cm-tiry that I have surveyed -the -fol3owing
durcribe
(I
n-• A.;A..HA A or-.
ELY
M-col-flisq: I'mxinct, Mask.), end that the.
Sjtjj:jj.CJl thereon arc within the property
lin- '-: and do rut uVerlUo or encroach on the 'property
16111. thereto, lll:tL tit) iniproveniclit3 on prop-
lyil.,-; adj:wc-tit th(.-retu encroach on the promiscs.in
w.d Ihit tIM-L tire no ro;,dWays, transmission
%:ivs or other visible czjcmejjt4 owsaid property except
indicated 1,�-rcon.
ttd .1111", On Itiver, Alaska
-A:ky of 10
nonFBIT Land >
r -,
Ite.giatrrcd Land Surveyor No. CBO.L.S
BON -150. Eanle Itiver, Alaska
Phone 691-25,113
"'1NICIPALITY OF ANCHORAGE
j/D EPARTMEN HEALTH AND ENVIRONMENT,_ rROTECTION
825 L Street, Anchorac:P, Alaska 99501
264-4720
Date Received: April 20, 1978
#1: Time 10: a.m. #2.: Time #3: Time
Date 4-25 78 Tuesday Date Date _(�aa/-7 _(L)_J .4s
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
Mailing Address: Phone:
2. Property Owner: Duncan Mc Leod Phone:
Mailing Address: % Jo Davis, Executive Realty, 276-7777
3. Legal Description: Lot 5 Block 2 Mountain Manor Subdivision
4:, Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
5. Well System:' Individual Well (y) Community/Public System
Permit # Depth of Well Well Log on File 1V).
Construction _ Bacterial Analysis
6. Sewage Disposal System: On-site System k7j Public Utility ( )
Permit # _ 77683 Installed iq`1-1 Installer
s
Septic Tank Size -� �n IManufacturer 1 11.
Absorption Area QnC)s,,' Soils Rate Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
'to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 2 Mountain Manor Subdivision
Comments:
Affadavit Attached: ) Letter Attached: ( )
Approved Date:
Disapproved: Date.
Department Worksheet:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENViROINMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF (&c-, c(52q q
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
CMRO—___—__.__VA.__---__-_-_FHA—_____--CONV.__�_"'_w_.._._
R
2. Property Owner:_._:
_<_:
'�— �' �
�__ __ ------
._- _Mailing
MailingAddress:—. -A____._.
-------._---
Day Phone:__
3. Name of Buyer : ---------
------
--
--- -- ._. _
Mailing Address:-------_-_---
Day
4. Name of t -ending Institution:___--_----------..__._.___--.____-----.---.____
Mailing Address: __Phone:_________--__..._.
_-
5. Name of Realtor or Agent:
Mailing Address:
_---Phone:_
6. Legal
7. Type of Facility to be
8. Water Supply
Type of Supply: Public Utility__..,_._
If Individual, number of dwellings presently served
If Individual, depth of
8. Sewage Disposal System
Type of System: Public Utility----
If
tility----.If Individual, date of installation
72 003(3/76) 003(3/'76)
No._... ----
Individual
Individual (on