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MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 18
Onsite File Mountain Valley Estates #1 Block 5 Lot 18 #050-651-10 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201011 PID Number: 050-651-10 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex,(D) ❑ Two Single Family Project: ❑ New N Upgrade Name Edward &Renee Racket -Carter Chapman ABSORPTION FIELD ❑ Deep Trench Q Wide Trench El Bed El Mound Site Address 4121 Johnny Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft, Gravel depth beneath pipe 1.0 Ft. Subdivision Block Lot Mountain Valley Est #1 5 18 Fill added above original grade 1.0-0.5 Ft. Gravel length 3@44 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift StationLine �Holding ewer Total absorption area 750 Ft, Number of trenches 3 Dist. between trenches 6+ Ft. Well 100'+ 100'+ n/a n/a 25'+ TANK l9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ n/a n/a Material Number of compartments Lot Line 51+ 10'+ n/a ' n/a NA Plastic 2 Foundation 10'+ 10'+ n/a n/a LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer Whitter Excavating PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Drainfield 3034 CO/MT 3034 inspector Pannone Engineering BENCH MARK (Assumed elevation) 1830 +/- ft Inspeection ction is` 7/13/20 2nd 7/13/20 31" 7/14/20 4"' 7/23/20 Location and description Bottom Trim @ point B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date cb TH .... Steveii F. raniiorie CE 8 4''9JJ s1F72 "i'�� ` iPROf �$$t001 Septic System Approved �-���� ( Date �0 )00 Note: this approval does not include well permit requirements.�```�0`��' VJ/VL/I01 nn o� t on uL t� 0DVecs E w -v ,�o� l S� Y10 LV� I -�p cicv�� U r� �L_V_\ ) 1A U) I �' APC C1 ^% beel ro cc�e.d s e --1- -� ; n� I `- �I' o t -4 s ► de rhe_ C7 rrl CO z cl) L O n cr (� frTl X :CJ -i y=am 00 oz—o�D z c c rA� �o00�O Cn ? DZ m m� c oz� N zr�i -. m> O X -. r rn m 08 O:� A Dr :� w 02 c0 co F) E m O m O (n � K: C7 bOttm ap C) C) K C) K n E (� p -i -i 0 � O �.n Cn ? -P W W N N -. -. 0O N -. � 08 O:� :: :� w W c0 co m m O c0 W W N _tT' \\ p Z O(0 C0 N O cn \I O O7 O O un N W D �7 N OJ (n 6) 0) N W -P W c0 60 N (0 W co tD w v O rn rn c D c o o) O (n p (D W (D N -tom- i, O W Oo tT O) W J CD N N iU r) CO V N CO -#, O 0 ccn �(n D�D0 MOvZ X Z�o'm>O0;0;zr bOttm ap -7" / � DrC) , KC/( m .. r DO -u< mCM- OD lDD >30 xF- mX CZ) -{m 0 cn = p) GZmm�Cz 7 O cn tT -' m cJi� crO0 o-occnn c7D mm mz o< O j N to K 00 � � > to p r� m C) p O < D rn o S Cf) m \ 0 0 / / L / a m _tT' \\ p Z O p p \ ` -nFri m -7" / � N u) m mN mm mz o< /m r z JOHNNY r DRIVE/ f-/ // m 0 m -0-t o \ 0 0 / / L / _tT' \\ p Z \ ` -nFri m Ir m it , 21 m / _ Dp z w z o m 0 tnmcn z-1 mD�D Zotv:. n�o / — m m D / / Om –t 0tn — V om oom "m ~ iiia m m m x D O � o, uy- mmm /* =�Fri mina O U o __ n >F D O F / W 1 -- -" zo mx /— r O / �/ / _ -00 to r -m vJ mmm— m8 NOTES: PANNONE ENG SVC LLC AK LFAX C.I. 1088) 99645E """.t, OF REVISIONS DATE 7/2020 RECORD DRAWING PHONE (9087)X745-8200 907) 745-8201 - �P�MER, AC�S�r'+ REV 1: 8/14/2020 SCALE MOUNTAIN VALLEY EST#1 B5 L18 = P.I.D. NO DRAWN ACP CHRIS AXTELL ...-........... = Steven R. Ponnwie ; -10 PERMITNO. PEOSP201011 4121 JOHNNY DRIVE "N. °E-819 _' SITE PLAN EAGL; E RIVER, AK _ " "I ' _ SHE 2 OF 2 Carroll, Rebecca M. From: Steve Pannone <Steve@panengak.com> Sent: Tuesday, July 14, 2020 3:30 PM To: Carroll, Rebecca M. Subject: RE: Mountain Valley Est #1 B5 L18 Becca, I was on site about 12:45. 1 noticed the poor soils and had that trench slide to get out of the poor soils and back into the good soils. Steven R. Pannone, P.E. Pannone Engineering Services, LLC Office: (907) 745-8200 Fax (907) 745-8201 www.Panengal<.com From: Carroll, Rebecca M. [mailto:rebecca.carroll@anchorageak.gov] Sent: Tuesday, July 14, 2020 12:34 PM To: Steve Pannone <Steve@panengak.com> Subject: Mountain Valley Est #1 B5 L18 Steve, Tim did the bottom of trench inspection at noon for Mountain Valley Estates #1 B5 L18. He observed blue clay with standing water (and water weeping from the side of the bank) for half the length of the middle trench. Tim told the contractor to contact the engineer for how to proceed. Not sure if anyone from PES has had a chance to see bottom of hole for the trenches. Tim was there from noon until about 12:20 and didn't see anyone from PES. Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 1 I WELL 10' UTILITY EASEMENT Lot 5 Lot 17 Lot 6 PLOT PLAN --- AS BUILT -2�- SCALE 1" = 60' GRID - SW 0758 Project NO. 17-354 A2 --- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n C, (907) 522-6476 Phone - (907) 5224625 Fax Professional Land Surveyors ken0langsurvey.com lonothan0longsurvey.com ©5P �6_ I 51Xl>- I hereby certify that I have surveyed the following described property: LOT 18, BLOCK 5, MOUNTAIN VALLEY ESTATES, ADDITION No. 1 (PLAT 74-17) 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 sold property except as Indicated hereon. , i -'o - 101� Dated this the --LL--- Day of --- i -I -01 -, of Anchorage, Alaska If Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201011 Work Type: Septic Renewal Tax Code Number: 05065110000 Effective Date Expiration Date: Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 18 G:0758 Site Mailing Address: 4121 JOHNNY DR, Eagle River Owner: RACKETTE-CARTER-CHAPMAN Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy C r Department 2/4/2020 2/3/2021 Lot Size in Sq Ft: 67231 Total Bedrooms: 4 ❑ 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: _ M:� 8,1t�) Date: L/ Date: / ��Q MUNICIPALITY OF ANCHORAGE Development Services Department 4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-651-10 Property owner(s) Renee Rackette-Carter-Chapman Day phone 907-786-6484 Mailing address PO Box 772233 Eagle River, AK 99577 Site address 4121 Johnny Drive Eagle River, AK Legal description (Sub'd., Block & Lot) Mountain Valley Estates #1 BLK 5 L18 Legal description (Township, Range & Section) Lot Size 67.231 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank X❑ Upgrade ® Duplex ❑ (D) Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property o�ivner or authorized agent) Permit/Rush Fees: A 1H 5 Waiver Fees: Date of Payment: 1 , 9 10, OAU, i Date of Payment: Receipt Number: y'7 51-1 Receipt Number: Permit No. © S P ` o 10 -'1 1 Waiver No. GADevelopment ServiceslBui[ding Safety\On site Water and WastewatefformslClient FormsTermit Application.doc MUNICIPALITY OF ANCHORAGE moment 7 • On-Site Water&Wastewater Program N.0 S�,^ Irl PO Box 196650 4700 Elmore Road a ® � l7 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 -••• eo 7'K' httpa/www.muni.orglonsite // 1)(•l)artm11 On-Site Wastewater Disposal System Permit Permit Number: OSP181265 Effective Date: 8/16/2018 Work Type: Septic Upgrade Expiration Date: 8/16/2019 Tax Code Number: 05065110000 Site Legal Address: MOUNTAIN VALLEY ESTATES#1 BLK 5 LT 18 G:0758 Site Mailing Address: 4121 JOHNNY DR, Eagle River Owner: RACKETTE-CARTER-CHAPMAN Lot Size in Sq Ft: 67231 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: IBJ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing • r �r Received By: - ,���,��� 1 Date: • Issued By: 1 / / Date: U 6 i E.PLANM MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division - Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-651-10 Property owner(s) Edward & Renee Rackette-Carter-Chapman Day phone Mailing address P.O. Box 772233 Eagle River, AK 99577 Site address 4121 Johnny Drive Eagle River,AK Legal description(Sub'd., Block & Lot) Mountain Valley Estates #1 B5 L18 Legal description (Township, Range & Section) Lot Size 57,231 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field ❑x Initial ❑ Single Family(SF) ❑X (w/wo ADU) Septic Tank ❑x Upgrade 0 Duplex(D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Dis tance: 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: X104 Waiver Fees: Date of Payment: �f!3/tg Date of Payment: Receipt Number: d $ 5-6 Receipt Number: Permit No. (.1P/5/ 006 Waiver No. Permit App_:-' ::.._:c: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181265, Deb Wockenfuss, 08/16/18 NOTES & SPECIAL PROVISIONS: 1. SCOPE AND SPECIFICATIONS: 1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 1.2. SCOPE OF WORK: INSTALL NEW 1250g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM. 1.3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 10 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 10 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 1.4. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER; A PLOT PLAN DEVELOPED BY RLS; OR A SURVEY AS -BUILT. 2. CONSTRUCTION SPECIFICATIONS: 2.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN 2.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. 2.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO t1" PRIOR TO INSTALLING THE PERFORATED PIPE. 2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. 2.5, ALL INSULATION SHALL BE 2" THICK DOW HI -40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES. 2.6. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. 2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. 2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 2.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MOA CODE. 2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM. 2.11. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. 2.12. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED. 3. CONTRACTOR RESPONSIBILITIES: 3.1. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 3.2. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 3.3. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 3.4. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 3.5. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 3.6. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED -LINE AS -BUILT DRAWINGS TO THE ENGINEER. THE RED -LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 3.7. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN -OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 4. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS -BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: DATE: PRIMARY/RESERVE DESIGN PARAMETERS PRIMARY DESIGN PARAMETERS NO. BEDROOM: 4(600 gpd) TANK SIZE: 1250g PERC RATE: 6.0 MPI SOIL RATING: 0.8 GPD/SF AREA RQD: 750 SF RF: .88 ADJUSTED AREA: 656.25 SF SYS. TYPE: WIDE TRENCH 1.0'ED MIN LENGTH: 132 LF USE: (3EA)44.OLFx5.0'Wx1.O'E.D., 4.0' TO TOTAL AREA: 660 SF RESERVE DESIGN (NIC) NO. BEDROOM: 4(600 gpd) TANK SIZE: 1500g ADVANTEX (CAT III) PERC RATE: 6.0 MPI SOIL RATING: 5.0 GPD/SF AREA RQD: 105.0 SF SYS. TYPE: WIDE TRENCH 1.0'ED MIN LENGTH: 21 LF USE: 21.OLFx5.0'Wx1.O' E.D., 4.0' TO TOTAL AREA: 105.0 SF 1 2 3 4 5 6 7 8 9 10 11 12 13 TEST HOLE 1 BOH TOPSOIL SILTY SAND & GRAVEL SOILS LOG READING DATE NET TIME WATER LEVEL READING NET DROP RATE (MPI) I 03AUGIB 5.900" 2 10 MIN 11.250" 5.35' 1.86 3 5.900" 4 10 MIN 10.400" 4.50" 2.22 s 5.900" 6 10 MIN 10.340" 1 4.44" 1 2.25 WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -NA-' BEDROCK DEPTH TO WATER AFTER MONITORING? - DRY - DATE: 10AUG2018 DATE PERFORMED: 03JAUG18 SOIL TEST RESULTS/ANALYSIS • PERCOLATION RATE 6 (mintinch) (Hydrologic Soils Group: HSG A) • USE 6-15MM RATE • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 3 FT AND 4 FT • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED, COMMENTS: Test hole excavated by ALBORN CONSTRUCTION. PERFORMED BY: Aaron Paradis. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. In "i WELL E I \ 1 9 18 \ \ INSTALL 1250q SEPTIC TANK P W/ FC BEFORE, DCO & DISTRIBUTION BOX w \ \ \ ` \ \ AFTER/ CONNECT TO CENTER OF DRAIN FIELDS > \ \ ,, \ 1785 VEWAY I SETBACK no ` INSTALL DRAIN FIELD P ,,-- STREAM VELL E I \ �' 1 > (3EA) 44LF x 5.0'W x 1.0'ED, 4.0'TD \ i I \ 121.3 \s\\ \ 1 INSTALL CO'S & MT'S AT EACH END \ \ ADD 2" R.I. & FILL TO ENSURE 3' COVER L 110. H-1 PE 0 I �I 10p � PROO��� N I \ \ \ 17, 90 \ 16.0 \ \ \ 10.0 RESERVE AREA NIC \ \ \ \ REMOVE SEPTIC TANK E I \ \ \ I BASED ON CAT III \ I I \ \ PER MOA CODE I \ \ \ \ \ \ \ \ ABANDON DRAIN FIELD E \ \ \ \ \ 1795 \ \ \ PER MOA CODE \ \ \ I \ I\ 'tyF�� GS \ \ I \ 1 I ) I \ \ \ \ o�� CI��Zop t \ f• ( / 1835 1830 1825 tato 1610 / 1 1800 805 1815 \ \I I I I I I (5 \ L 1 L I ABBREVIATIONS TH TEST HOLE (P) PROPOSED \ \ (E) EXISTING W -WATER LINE / WELL RADIUS CO CLEAN OUT NO. MT TEW SEPTIC II \ TYP` TYPICALMONITOR TUBE N0 1820 - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - 1875 - - - - - - - - - - - - 4- - - - - - - - - - - - - - - - - 4.0 tato - - - - - - - - - - - - - - ,- -� - - - - - - - - - - - - 4.0 R I TW - - 1805 - - - - - - - - - - - - - 70.0- - - \ 4_11 - - - \ - - - - - - - 1.0 10.0 1- 1.0 �1 -PEI - - - - - - - - - - - - - - - - - - - - (yS -- q /4 SECTION CA 469 ��\Rgr�o - - - - - - - - - - - w 0 U � C�J�rnm� wzJNmN� o T O Lj n �a N n z W W xuNN U O <�>oo�m CL cl a � cn REv2: EET C3.4 1 OF 1 NAME ~._~ MAILING ADDRESS LEGAL DESCRIPTION LOCATION I Well ,, ~ Absorption area I DISTANCE TO: / )~-'~ .. -~ L ~" ' I-- :~ I Manufacturer ~ ~Liq, capacity ia gallons I ............. I Inside len~ DISTANCE TO: IWell - ~ I '~;' Well ~ z I DISTANCE TO: [ / ~ ~ Z ~ No. of hnes ,, I Length of earl.line/ Total lengt~o~Ji~es L / I ~] ]Top of tile to finish grade ~/ ~ Material beneath tile uJ / LengtI h Width /Depth ~ ~-- Cribdiamete~~4ribdepth u~ ~ / -- ~ IClass ~.. ~ 3epth Driller ~ DISTANCE TO 3uilding foundation Sewer line MUNICIPALITY 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 PHONE [] NEW Material Nearest lot line I Trench ~//J inches '7~, inches NO. OF BEDROOMS PERMIT NO. No, of compartments '2~ Liquid d:e_~p t h~ PERMIT NO, Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorptio~area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO, Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER ~EMARKS LEGAL PERMII" NO. RPPL I CFINT LOC N"[' I ON LEGFtL '.=.;OUTH FOAl< CONSTRUCTION L.±8 B5 MT '¢FILLEY ESTFITES PO BOX 567 E.R. 995'?7 LOT SIZE 694-4]:5t 999999 SQI.JF:IF.:E FEET TYPE OF '_"-';OIL ABSORPTION SYSTEM IS: TF..'.ENCH I"IR;:'::IMUH I"JUI"IBER OF BE[:'ROOHS = SOIL RRTIHG ,:'.SQ FT,-"BR)= 275 ]"HE REQUIRED SIZE OF ]'HE[ SOIL FIE:SORF'TION SYSTEM IS: [)EP'I'" FI =: :.t,El L E ~-4G T'H= :E: 22: (3 F:: F~ "..-" E t_ [:" E F"]- F4 :: ,5 THE LENGTH DIMENSION IS TFIE LENGTH ,'IN FEET) OF THE TRENCFI _IR [:,RFIINFIELD. THE DEPTH OF FI TF.:ENCH OF.: F'ZT IS THE DIS'T'FINCE BETHEEN THE SURF'RE:E OF' THE GROUND RHD THE E:OTTOM OF' THE E,'.'::CRVFITION ,::IN FEET). THERE IS NO SET NIC, TFt FOR TRENCHES. THE GRFIVEL C, EPTH IS ]"FIE MINIMUhl DEPTH OF' GAFf'eEL BETHE"EN THE OUTFFILL F'IPE FIND THE BOTTOi'"I OF THE EXCFI'v'F:iTION (IN FEET). F'EF.'.MI'I" FIPPLICFINT HFIS THE'_" RESF'ONSIBILITY 'TO INFORM THIS DEF'RRTHENT DURING THE INSTFILLFITION INSPECTIONS OF' FINY WELLS FID._TRCEI'.,IT "FO THIS PROF'EF.'.TY AN[:, THE NUMBE:R OF RESIDENCES THFIT THE NELL HILL SERVE. E:FICKFILL. ING OF FINY SYSTEM NITHOUT FINFIL IN.=,FEL. TION FINE:, F:IF'F'RE¢,,'FtL E:"r' THI"""" DEPFIRTI'"IENT I-,.IILL BE SUE','JECT TO PROSECtJTION. i"IINIMUM DIS, TRNCE E:ETNEEN FI NELL FIN[:' FINY Ci",I-SITE SEWAGE [:'ISF'OSRL SYSTE']'"I IF; :I~EE~ F'EET FOR FI PRIYRTE HELL OR ±5C4 TO 28¢ FEET FROM FI PUE:LIC NELL DEF'Ei",I[:'ING UPOI"4 "tHE.~ TYF'E OF PLIBLIC HELL MINIMUM DIS'T:FINC:E FF.:Old FI PRI',,,'FITE HELL TO FI PRIVFI'TE SEHEF.: LINE IS 25 FEET FINE', TO R COi',IMUNITY SEP.IEF.: LINE IS '75 FEET. ()THER REg!UIF.:EMENTS MFIY APPLY. SPECIFICATIONS FIND C:ONE;TFi:UCTION DIFIGRFIMS FIRE: FIVRILFIBLE TO INSURE PROPER INSTALLATION. I CEF.:'rIFY THAT 1: I Ah1 FFIMILIRR HITH THE REQUIREMENTS FOR ON-SITE SE'I.qERS AND 1.4EL_L.S RS SET FORTH BY THE MUNICIF'FILITY OF ANCHORAGE. 2: I NILL INSTFILL THE S"r'STEi'"I IN FICCORF:,RNCE !.4ITH THE CODES. -'-'.: I UNDERSTFtN[:, THAT ]'HE ON-SITE SEHFF.'. SYSTEM I"IRY F.'.EL.':~UIRE ENLFIRGEMENT Il::' THE RFSI[:,EI'4CE .:I.~,.F..EIIU[.,ELED TO INCLU[:,E i'ILF.E TFIRN 3: BE[:,ROOMS. RF'F'L I CF 'iT sAG:THFF,T,E.E',:-:.'ONS YR L EY76F4 / / ~Permit ~: 820386 January 31, 1983 TO: Permit Applicant Subject: Lot 18 Block 5 Mounkain Valley Estates Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and 'to close the permit. If a prlvate engineer inspected the installation of the on-site sewer system, please have them send us -the as-builts for our files and documentation. If there are any further questions, please call this office at 264~4720. S incer e 1:~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 F'f.i;F'M '.' T 61 t::' P L ! Ii: I:lt"J 1" : ~:1T T Z H E; '."d...I TH F:' -'F ,I-,' [:,.. HT ','Fill r:'¥ FZ:5'T HF::I>:',It','tL!H I'.,IIJHE~ER OF E:Er,,q""'.:I',I'S .... 'I"HE LF'.:NGTH E:, i i'"IEi'.,I:~:; I Cd'm,! :r. LE; THE L. IEI'.,IGTH ,:: :i: !",1 FEET 1:, EIF-: 'THE 'TRE:i'.,tC:H OR D!:;i:Ft i I'.JF'I ELD. THEE C,E:F:'I"H OF' I::1 TRENCH OFi F':[T ]:~5 'I'HE [::,I:~;Tt:::!I'.,K::[~: E',E'Ft,~EEI'.,! TI-II!!: SUI;RF:F::!CE OF:' THE ('JiFiiEILtNC, F:II'.,IB, 'I"I-IL:: E:CITTEIH OF 'f'HE E;F:iE:FI',,,'FFI":iJEd'.,! ,:: ):N FEE:T). 'T't'.![.'-.::F~'.F:~ :[ S i'.~C~ ~SE"t" H :!: [::,TH F'OI:;~: TF:-:'iE:.'I'.,ICFI!E:ii:;. THE C4F?.Fi',,,'..r.:i:L [).EF'TH :l.'::~i; THE: H I !",! :[ HUH I)EI:::'TI-I I:::ff.,l[) THE [3OTTCU'"I OF' THE: EXCFa',,,'F:I'T' ! ON ,:: I Iq I::[.ZET ::,. !:::'IEI:RH :1: 'T FIF'F'L. :[ CF:IF,Fl" l...ll::dF THE: F.:E: Bf::'E f.,t'FJ '~ E', i L 'J: '1"'¢ Tl::l :I: f.,II.::'I:::~F;:f,1 TH )1 :.:; C,[;F'F:ff;:THENT [::,LIt':~: :l: I",.G 'THE: :r. 1'.,!:STF:ILL. FIT :[ E!!'.,t :1: i'.,I~;P!EC:T :1: '.'ll'.t'!~ F' F' F:lh,l'./ !.,.IE[.J...:iil; F4[::,..:rF:!C:E:I'.,IT ",r'O 'FH :[ ~5 F:'F4:EfF'EFN"¥ FIND 'T'!...I[E i'.,iI.I','.F(!!:F;.: Cfi:: F,'::":"[::,E'h!F:I:::"::; ............ 'I"I'~IFFF THE: I,.IEL. L. I.,.l'rL.I ..... ': F'F' '1:'"~::.. ['"t I I'.,! i HUH [::, :1: :ii;'i~FINCE: 13ETI.,.IE[:.:N l:::l I.,.11::~:1_..I.... FIHD FII'.,t'~.' ON....:~:; :[ -I"E: '.!i;IE!,.IFIGE [::, I :E;I:::'E~E;i::iL '.B'.r':':FT[ii:H :1: 'B ::[.E~i!) F::EE:T F'OF;;t F:! F'Ft]:',,,'F:FFE t.,.h~:L.L OR ::L~:~:Jl?'J~ TO LIF'EiF.! THIE 'T'"r'F:'E: OF:' F:'UBL I C HE;L,I ..... i"'! ! .N ]: HLIH [::, :[ S"!"f':ff',ICE F:'F:OH F:I F'P:'. :[ ',,,'f:¥T'E HEL. L. TO I::~ C:OHHI...tlq:[T'.¢ 5EI.'.!EF.': I....L(I",tlF.' :Iii:J; 7'!!!11 O"I",LIE:F.: F.:E:(;:!t...I .T. I:;i:!EHE:N'i':i!i; Hl':l"r' F::IF'F:'!...."r'. :ii.:;,F'Ei:E: .1:. F' I E:f::I'T' F:I",,'FI :[ I....FIE~L..E TO Z I",I:E;LIF~:E PF;;:OF'E:,r.;;: :[f',rI:ii;'TFILL. F-IT :f. :1: CER:T I I::'"/ 'I"HFI'T' ::1.: ! F:It'"! I~:'I::IHIL. IFIF.', H:['I'H THIF_' I:;~:E:('::!iJI!:',?.E:H[F:BFI% F'OF;: CII",F'-':ii:;ZTE: !~i;E:FtE:I:~t:E; F'IF,!D I,.IEL. L.:~i; F:OF~:TH Ei?'r' '['HE: P'IL,IF,t :[ E: ! F'RL. I T"r' O1::: F~NCHOF';:F:tGE. ;2: i !.4 Z I....I.... I i",I~2;TFILL. THE ?¢:5'1"!EPi Z I"~ F~C:CEtR[>FII",~C:E: !4 :[ TH THE 2.:: :1: I.Jf',I[::,[EF;:~?D THFIT THE: Eff',F'":B:[TE: ~:[CI,.!EF;: :~;"/:E;TEH I"1Ft'¢ [RE(;d...I:[[~:E: ENLFIF;i:C4E:h!IENT f:: :'P'T '",... I'.F''::: *' F "' F'~ ....... / / l:::, 'r-...../-,.-.~--.A.:, ................................................... :,: .::.:.,,:~....,..24 .¢.....t..dd I b ............... :.../.....L:....... x..../....&: ..... i~,~.~' ~---l~ MUNICIPALITY 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 PHON~ I ~NEW LEGAL DESCRIPTION ' ' . , I~el ' Ab orp ' t Dwelling ~_ I ~(' DISTANCE TO:~/I I 0 ~ ;~ *} com~tments ~ Manufacturer Ma¢~~ No. of Liq, cap~; bg~X' ~' ~~ Inside length Width Liquid depth IF HOMEMADE: ~--- ~._ ~ ~ ~ Well DISTANCE T~ -~) /~' ~ Dwelling PERMIT NO, , .eare'tlotlin~/; PERMITNO. ~ ~ ~ No. of ,in~s L.n~th of each 17~ Total length o,~,e~ Tre,,ch widtl~inches- Distance between lines, N~ Top of tile ,o finish grade ' ~ ~.~ Material beneath tile r Total effective Length Width Depth PERMIT NO. ~ ~ Type o~ jrb d /-- Crib d ~ 'x Total effective absorptfbi~ ar~ I~ ~ ~TANCE TO: ~el~ K- ~ing foundation ~ear~ot lin. .~ Cla~~ Depth Driller Distancetolotline~/~ pERMI~[N~ 7 ~ " Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS REMARKS ~-~, a.~,e~ __ 72-01: l:::ll::'l::'L ]i L':: Fll",[ T L 0 I::F:t T i[ 0 N L. E GI::II .... THE F:i:E(i:!L.I:I; F:E:.[::, ':'!i; :[;~E OF: TFIE %0 ]:1,. I::lE::;OFd::"f' :[ ON ~5't':'~;TEH ]: :5: THE L.t~i:NC.i'T'I~I [::, 11: HEN:;:; 1[ Ol'-,l :( :-; THIE L.E:NC!i'I'H ,:: I H FEET ::, OF: THE I"I;i:EI",ICH OF:i: Ii:,I:RF:1:1.' j'.llF' 11: EI...L':,. 'I"I4E B,I:F:'TH OF f:l TRENCH Og: F:']:T ;IFS 'f'FIE F:,I'::;'FFINCE BI:!!:TI.,J. fi!:E:N THE ':'5LII:;~II:::I::ICE{ OF' TI...II::: l:~iFl:CILIl'.,Ib FIN[i:, TI-II:: E:OT'T'OH OF' 'FHI:E Ei:':iC:FI',,,'FI'T ~ ON ,:: :1:1'.,1 F::I!!':E"f' ::,. TI.'.IE[;iiE 1: !.~; I'.,IO ~;[~!'T ,L~I:t: DTH l:::'OF'. THE: Gf~:F'I',,,'[~::L DEEF"T'FI :[:!5 'FFIE: Pt :I: i'.,I :I: HI...IH DE'F"FI-I OF:' C'iF;II:::I',,,'L::L. E:E"FI.,.II:::itEi'.,I THE OI...H'f::'FILJ... I:::II'.,tB, 'I"Hi::: E:OTTCIH OF' THE Ei:-:iC:FI',,,'FIT.[ 01'.,I ,.': .T. N I::'EiET 1:,. H :1: I~.,1:1: HI...Ih'I E:, ]: ~:;'I"I::INC:f:!: E:ETHEE:N Fl HELl.. I::lt'-,l[::, FIi%.' ON..-.~;;[ TI!i: '.~;Et.,.ll:::ll:iti: ::LO0 F'[ZE'T' FOF.': Fl P~'.]:',,,'t::ITE I.,.iELL..~ ::1.!50 '1"O ;::OO f:'~Et:.'f' F:'l::b:)H FI F'l..iE:l.. ]: C HELL. I::,EF'I::t',ID :[ I'-,ll:i LIF'ON -f'HE 'l'?F'i'!i: OF' F:'l..ll:~:l... :!: i::: I.,.ll!i.:L.I .... I.,.II!.i:LL. I...J'.)~:~i'.:!~ I:If;i:E~ F.':E(:?LI]:F?E:D I::INI::, HLI:i:;'f' I:::E F:ETLIF?.NEI:::, TCI THE OF TI...IF~ I.,.IEL. I_. O'I"HEF~: l:~.:Eg!l...I il: t::::EHf.:.:NT'>:; i'"ll::~"r' I:::lF:'F:'L"r'. :::.;F'I?:C :1: F::'Z CFIT :1: OH:~; FII",ID CCIN:i!i;TRI...ICT I:::l'v'F/] I...FII:~:LE TO ]: 1",t:51...hq;:l~ii: F'F.'.OPEF:: :!:J",l:!?f'l::lLLf¥t"] O1",t. ::t.' :[ I:::IH FrF:iH ): L_ ]: I::tF~: I.,.I]:TH 'I"I4E: F.:I~::g!I..I:[Fi:EPII~Si'.,I'T':;~; F'r'J-;:FH E, THE: HLII'.,I:[ :: '[ F:'l:::l[ ~(T"r' OF' ;'.:::]: H ]: L.L :[ I",I'.!?I"FIL. L THE ':;"r'~:~;TIL'H .1:t'.,I FI(::COFit[::'F~NCE: H ]: TH THE CODE::!:. ";" :[ Lll",l[:',~i¥':::i'.:Tl::li",![::' TFIFl'r' "FHl:i Ol'.,I.....tli!;]:Tl!: ..... .l~..., .... :,[:.1. ,Et. :'5"r':!:i;TE:H I'"lFt"r' [Rl:::g!l 1:1: I:;~:~!:' E:NI...FIF::GI:I'"Ili.:.':HT :!: F' 'TI'II::~: I:;'Ei"::: "I"'I'~'I"I':'E :!::~i; f~:Et"IODE:LI:!i:I::' TO ]:I",IC:I.J..IDt~ Hi:if:F: THFII",I :~i; :1: ~:~ I'.,IE:[::,: .......... :~_~ ~b:.: ........ ~...~x:~ .................................................................................. / [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPAFITMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221' SOILS LOG- PERCOLATI TEST PFRFORMED FOR: ("~ · EGAL DESCR,P~',ON: 1 DATE PERFORMED: PERCOLATION TEST SLOPE SITE PLAN u.x --t--~-- I F"F--4.. lO 11 12 13 14---- 15 16 17 18 19 20 COMMENTS?~ WAS GROUND WATER¢,/"~--'-- ENCOUNTERED? ' ~ ~ IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop .... PERCOLATION RATE ~ (minutes/inch) TEST RUN BETWEEN G FTAND PERFORMED BY: -;' / / 72-O08 (7/76) by DOC Co. dDa SULLIVAN WATER WELLS P.O, BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended KIND OF FORMATION: From__Ft, to From__Ft. to__ From__Ft. to From__Ft. to From____Ft. to__ From____Ft. to From___.Ft. to_ From .Ft. to___ From__.Ft. to___ From____.Ft. to From Ft. to From__.Ft. to-- From____Ft. to From Ft. to From____.Ft. to___ From____.Ft. to From Ft. to Ft. _Ft Ft. _Ft. Ft. Ft._ Ft._ Ft. Ft~ Ft._ Ft. Ft, Ft. .Ft._ Ft. Ft. Ft ._~IUI~..CIPALITY OF ANCHORAGE '~"t':~ONMEJqlAL FT, O J'ECI'ION SEP 2 lgTg RECEIVED DEPIIt OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft, to__Ft. From__Ft. to___Ft From__Ft. to__Ft From Ft. to___Ft From .... Ft. to _Ft, From Ft. to Ft. From Ft. to Ft._ From Ft. to_ Ft. From Ft. to Ft. From Ft. to__ Ft, Frmn__.Ft. to____Ft. From __Ft. to .... Ft. From Ft. to Ft. From __Ft. to Ft, From Ft. to Ft. From Ft. to Ft. From Ft. to _Ft, MISCL. INFORMATION: DRILLER'S NAME APPLI¢ NT FILLS OUT UPPER HAl Property Owner ¥1. ONLY tPhone Mailing Address Buyer '~, .~.~') t ,, ', Address Zip Code-/-:¢;'i i / Zip (;ode Lending Institution \.;.,, ~/)....,,' '~ Address Zip Code Realty Co, & Agenl ........... Address Zip Code Phone Phone Legal Desoription (.. Street Locatio~ Type of Residence ,~_,, Single Family 'FI Multiple Family No. of Bedrooms ~-~ _ [] Other Water Supply "~_" Individual '~, L" (~ "% /~]'"Community [] Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date. give well depth (attach log if available). Sewer Disposal ~,~'-] nd.ividual [] Public Utility [] Flolding Tank Year Individual Installed: When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time late Date Date/ / _ \'~_k~k~_j~_, Datec~ 3sp~tor Insp~tor Insp~tor Insp~tor Field Notes: ;~-r~PPROVED BEDROOMS 1.2 I B,S^P.~OVED ) CONDITIONAL APPROVAL' BATE BY: {' ' ~:--.~ ~'.~ ' MUNICIPALITY OF ANCHORAGE DEPT. OF HSALI'H & ENVIRONMENTAL PROTECTION RECEIVED 'CONDITIONS OF APPROVAL i Well Log Received Septic Tank Size / (.~_ ~;~ ~ Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank ~ ~.. ~ 12.023 (3182) 5 ~ %' ',c ':' ~\ ' DA~-~ RECEIVED INSPECTION APPOINTMENTS ~'~ME TIME TIME! DATE DATE DATE ' MUNICIPALITY OF ANCHORAGE MUNiCIPALITy OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION D~PT. OF H:.-ALI~ & 825 L Street - Anchorage, Alaska 99E01 ENVIRONMENTAL P:q2 FECTION ENVIRONMENTAL SANITATION DIVISION AU~} ~ 4 t~81 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, 1. PROPERTY OWNER PHONE Behold ~luha~ty 694-3772 MAILING ADDRESS PROPERT~ ~ESIDENT (If different from above) PHONE 2, BUYER PHONE ~oe~ick g&g-?71R MAILING ADDRESS S~ 3ox 163-9 Anchorage. A~ 99502 3, LENDING INSTITUTION PHONE O~l~ed ~an~ o~ Alaska (atEe~o~ An~3 276-1911 MAILING ADDRESS 645 G S~, ~cho~Age. Alaska 995fll 4, REALTOR/AGENT PHONE' C17de ~o~etC/O ~ck Nhlte Co 1277-1553 MAILING ADDRESS 3201 C S~, ~chorage, Alaska 5, LEGAL DESCRIPTION Lot 18 B1 5 Mt. Valley estates STREET LOCATION + Mi. 6.2 Hitand Rd.- 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [~ One E~] Four ~ SINGLE FAMILY E] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available. I 8. SEWAGE DISPOSAL SYSTEM [~ INDIVI DUAL/ON-SITE~ PUBLIC UTILITY 79 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE'. THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~rV~.~-- THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E] SINGLE FAMILY D ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY E] INDIVl DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ? ~'-~ ~"~ Connection Verified INSTALLER F-ISepti¢ Tank or [] Holding Tank Size: /OU/~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [] CONDITIONAL APPROVAL (letter must accompany certificate) BI DISAPPROVED 72-010 (Rev. 6/79) MUN C PAL TY OF ANCHORAGE .... r ~'" ROhMLt'R~AL I~OJECTI DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~i~I~ ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIPUAL WATER AND ~EWER FACILITIES DIRECTIONS: 6omplete ~11 parts on page 1. Incomplete reques~ will ~ot be prooessed. Please allow ten (~0) da~s for processing. 1. PROPERTY~WNER PHONE P~O~E~TY ~ESIDENT (If different from above) PRONE 2. BUYE~ ' PHONE' 3. ~ENDINGINSTITUTION [ PHONE I MAILING ADDRESS ' 4, REALTOR/AGENT I PHONE' I MAILING ADDRESS 'LEGAL DESCRtl;TION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS J;~'" SINGLE FAMILY [~ One [] Four [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] ~UBL C UTILITY 8. SEWAGE DISPOSAL SYSTEM [] IN DIVI DUAL/ON-SII"E** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to tl~t d/c. te, give well depth (attach log if available.)~ Gq 'T~'t~ '*If individual/on.site, give installation date ,/~ If system ~s over two (2) years old an adequacy test is reouired by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TiME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBL,C UT,,,TY Connection Verified IN~TALLE~ ~Septic Tank or ~Holding Tank Size: /~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line ~ Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~ CO~DITIO~Ak A~BOVAk {letter must accompan~ certificate) ~ DISAPPROVED DATE BY (Title} LEGAL DESCRIPTION 72-010 (Rev. 3/78)