HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 2 LT 25Municipality of Anchorage
3 2 7A
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: _OSP231415 PID Number: 015-302-49
Dwelling: FNI Single Family (SF) El with ADU 171 Duplex (D) El Two Single Family Project: El New nN Upgrade
Name
ANDREA WILLIAMS
ABSORPTION FIELD SOUTH/NORTHJ
nN Deep Trench El Wide Trench n Bed El Mound
Site Address
5346 WHISPERING SPRUCE -ANCHORAGE, AK
El Other
Phone
Number of Bedrooms
Soil Rating
JTotal depth from original grade
907-980-5518
14
0.8 GPD/SFJ
9.70/9.75 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
-SEE DWG. Ft.
Gravel depth beneath pipe
7.5/7.5 Ft.
Subdivision Block Lot
SKYRANCH ESTATES #2; BLOCK 2, LOT 25
Fill added above original grade
SEE DWG. Ft.
Gravel length
25/25 Ft.
Township Range Section
Gravel width
2.5/2.5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
—
Field
Tank
Line
750+ W
2
**10'+ Ft.
Well
*100
*100'+
*100'+
-
25'+
TANK El Septic [I S.T.E.P. [:I] Holding [01 Other
Manufacturer Capacity
GREER TANK 1500 Gal,
Surface Water
1001+
1001+
1001+
-
—
Material
Number of compartments
Lot Line
5+
**5'+
5'+
NA
PLASTIC
2
Foundation
10'+
10'+
10'+
LIFT STATION
Manufacturer
Capacity
Remarks *200'+ TO PUBLIC WATER SYSTEM **OSV231063
GREER TANK
***500 Gal.
***SECOND COMPARTMENT OF STEP TANK
Alarm location
Electrical installed by
RISING SON ELECTRIC
Installer
PIPE MATERIAL House to ank Tank to
3 03 4
Pi drainfield
ARM SEPTIC SERVICES
D3034 CO/MT D3034
Inspector GEG AND M.O.A.
BENCH MARK (Assumed elevation) 100.00 ft
Inspection 1st 1/12/2024 1/12/2024
dates: 2nd
Location and description
aro 1/15/202 41h 1/15/202 1
BOTTOM OF VERTICAL TRIM AT SW CORNER
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stamp
Conditional Approval: Date
..................
.. .............
Septic Syst
Approved 12
fre A G rness-'
"'N
C A� 3
Date -
Note: this apprav does not include well permit requirements.
X\- ro S 100
CC884
%rN,zv uulvzi !01
1795'
PERMIT NUMBER: RECORD DRAWING PARCEL ID NUMBER:
OSP231415 015-302-49
NOTE: PIPE LOCATIONS ARE
SHOWN PER GEG SHOTS
TAKEN WITH LEICA DISTO
S910 LASER DISTANCE
METER. SWING -TIES TO
HOUSE CORNERS WERE
GENERATED IN AUTOCAD.
SKY RANCH ESTATES #2;
BLOCK 2, LOT 24
a
LUUA I IUN OF
1NDONED IN PLACE
DBL1&2
MH1 O
MH2
�t
DRAINFIELD/S
10'+
72y�iS'
q
° a
d ° a
c DRIVEWAY a
°.
'
d
°
d.
GENERAL VICINITY OF 200' WELL RADIUS
STAKED BY PLS PRIOR TO CONSTRUCTION
EXISTING 4 /
BEDROOM HOUSE
NEW 1500 GALLON PLASTIC GREER TANK USED AS STEP TANK
— CONTRACTOR CONVERTED FROM
PRESSURE TO 4" D3034 TO DISSIPATE
ENERGY PRIOR TO THE FLOW SPLITTER
11
5'+ WR#OSV231063
�rSKY
RANCH ESTATES #2;
BLOCK 2, LOT 26
oo.�,rOF
►rrrr � � �
tij AV
�.
i
9 q .....::......................••..:
ENGINEERING � SALES CONSULING i
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA' PHONE' (907) 337-6179' WEBSITE. w.wv.gamessengmeenng.com. . .. ..........
� ,....t. ..... ..;.I
PREPARED FOR:or
PHONE NUMBER: PAGE NUMBER: on J rey G mess 417 /
ANDREA WILLIAMS 907-980-5518 2 OF 3 tj�iJ, CE -79.. 3 ' _.►'
PROJECT/LEGAL DESCRIPTION: DRAWN BY; t`�,p'.. 3I ?2 %�.+•�.A
SKYRANCH ESTATES #2; BLOCK 2, LOT 25 D.J.G. t+ ® pFE....
DATE:
oo•
TYPE OF WORK: LICENSE
SEPTIC SYSTEM RECORD DRAWING 1/25/2024 # 1 ENS 4 r`rrrre
PERMIT NUMBER:
OSP2311415 RECORD aRAWING
TOP OF TANK AT INTLET = 94.36
INVERT OF PIPE AT INLET = 93.67
TOP OF MANHOLE #1 = 10026
{1 TOP OF MANHOLE #2 = 100.33
MH1 j _ MHz 7 -FINAL GRADE = 100.18
TOP OF TANK AT OUTLET = 94.35
NEW 1500 GREER TANK WITH PUMP AND SIM -TECH FILTER
GRADE AT HIGHEST POINT = 99.86
FINAL GRADE = 100.42-100.76 FINAL GRADE = 101.11-101.53
NORTH
TH#i D 2" INSULATION PER CONTRACTOR
MT CO
F$1 -FILTER FABRIC
7
INVERT OF DISTRIBUTION PIPE = 97.61
7
BOTTOM OF TRENCH = 90.11
10'+OSV231063- --�
PARCEL ID NUMBER:
015-302-49
ORIGINAL GRADE AT HIGHEST POINT = 100.71
�2" INSULATION PER CONTRACTOR
TH#1
TER FABRIC
NVERT OF DISTRIBUTION
PIPE = 98.51
BOTTOM OF TRENCH = 91.01
RELATIVE ELEVATION AT BOTTOM OF T.H.= 84.71 (T.H. DRY ON 1/11/2024)
RELATIVE ELEVATION AT BOTTOM OF T.H.= 83.86 (r.H. DRY ON 1/11/2024)
"S EvIGINE'u"ING GRO"'UP, Ltd
ENGINEERING � SALES � CONSULTING
3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE. AK 99507' PHONE (907) 3376179 -FAX (907) 339-3246' WEBSITE:-.g..o..,gin ng wm
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
ANDREA WILLIAMS 907-980-5518 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY RANCH ESTATES #2; BLOCK 2, LOT 25 D.J.G.
TYPE OF WORK: DATE:
ASEPTIC SYSTEM PROFILE 1 1/25/2024
r§) \,�Sz 5653
r2y
N 5 3&,1gry�
0
3p
REVISED 3-20-24 Addednh es' �L{� \
1 RECERTIFIED 2-07-24�'
AS -BUILT Ni' CORNERS SET THIS DATE
0FAW
• �C �S� �
�'. 49th'
000.77 ..4. .,,. f0
`_ •. izabeth L Walatka ; x oO
/0r • • 8036 — LS - �A-
SCALE: 1"= 30' �l�a ` .. • '��°
si�"�
�.-4
EASEMENTS OF RECORD, OTHER THAN FB 23-2, pg 732-1 - ZG=P
THOSE SHOWN ON THE RECORDED FB 23-2, pg 66
PLAT ARE NOT SHOWN HEREON Recert 1-24-83 BE
UNLESS OTHERWISE NOTED. FB 73-5, pg 70
I hereby certify that t have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 25 BLOCK 2,
SKY RANCH ESTATES UNIT No._2
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property 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 Anchorage, Alaska
this 26th day of October 1973.
907-248-1666
FRED WALATKA 8 ASSOCIATES, L.L_C.
Engineers and Surveyors
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original
client or by others at a later date without the consent of Elizabeth L. Watatka is a violation of Federal Copyright law. Unless gross negligence is discovered,
the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
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: OSP231415
Work Type: Septic Upgrade
Tax Code Number: 01530249000
Site Legal Address: SKY RANCH ESTATES #2 BLK 2 LT 25 G:2737
Site Mailing Address: 5346 WHISPERING SPRUCE DR, Anchorage
Owner: WILLIAMS WILLIAM R
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
6111 r
l)el)artment
12/20/2023
12/19/2024
15423
❑ 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
Special Provisions:
1. The existing field is not to be connected to the tank.
2. The crib is to be decommissioned.
3. Prior to construction, locate the existing trench in order to ensure the 5' separation from the tank is met.
Y G
Issued By:
i
Date:
Date: �Zd� -
4
Municipality of Anchorage
- __ I)r.partmnni
P.O. Box 196650 s 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV231063 COSA#: Permit#:OSP231415
PID#: 015-302-49
Legal Description: SKY RANCH ESTATES #2 BILK 2 LT 25
Engineer: Garness Engineering Group
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the property line has been approved. The approved separation distance is 5.0 feet. In addition, the
field -to -field separations are approved to be 10 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date:/CA; Z3 Approved by:
Name of Reviewer
............................................................ .................
**** VARIANCE/WAIVER REVIEW ****
Development Services Department >
P p '=' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-302-49
Property owner(s) ANDREA WILLIAMS Day phone 907-980-5518
Mailing address 5346 WHISPERING SPRUCE *ANCHORAGE, AK
Site address 5346 WHISPERING SPRUCE *ANCHORAG.E AK
Legal description (Sub'd., Block & Lot) SKYRANCH ESTATES #2; BLOCK 2, LOT 25
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field Initial ❑ Single Family (SF) []
Septic Tank Q Upgrade x❑ (w/wo ADU)
Holding Tank ❑ Renewal ❑ Duplex (D) EJ
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
DRAINFIELD TO DRAINFIELD; DRAINFIELD TO LOT LINE Distance: 10'; 5'
1 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:,,05_'Z_!2_ Waiver Fees: 02.2. S
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
Permit No. ��J-�23 I l �_ Waiver No.
GADevelopment Services\Building Safety\On SRe Water and Wastewater\FormsUient FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231415, Deb Wockenfuss, 12/20/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231415, Deb Wockenfuss, 12/20/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231415, Deb Wockenfuss, 12/20/23
SCALE: V= 30'
r,o 5653
N 5 34,191,E
\ \ RECERTIFIED 10-24-23 L�LO
AS -BUILT NO CORNERS SET THIS DATE
�P,��• OF • 44
=
�,. 49th • .y �j,
000 00
00
00 . Elizabeth L Walatka : oo
�� ��F • 8036 - LS • aZ AV
AW
10 -
30
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 25, BLOCK 2,
SKY RANCH ESTATES UNIT No. 2
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property 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 Anchorage, Alaska
this 26th day of October '1973.
EASEMENTS OF RECORD, OTHER THAN c 2�L3
THOSE SHOWN ON THE RECORDED FB 23-2, pg 66 FRED A v ASSOCIATES, L.L.C.
PLAT ARE NOT SHOWN HEREON Recert 1-24-83 BE Engineeersrs and
nd Surveyors
907-248-1666
UNLESS OTHERWISE NOTED. FB 73-5, pg 70
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original
client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered,
the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product
,~.................~__¢~. ~ MUNICIPALITY OF ANCHORAGE
i(~' ~"'~,) 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
.:~PGRADE
/630
~ DISTANCE TO: I ~'/,~`,m bs°rpti~-area~o [q~ ~ ~ 3¢
Liq. capacity in gallons Inside lengtb Width Liquid depth
~ ~ ~ IF HOMEMADE:
, ~ Well DwelHng PERMIT NO,
O ~ ~ Manufacturer ~ Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO,
~ m ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
~ ~ Top of tile to finish grade Material beneath tile- Total effective absorption mea
Length Width Depth PERMIT NO.
~ b Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER ' --
SOIL TEST RATING.~
_ -
APPROVED DATE LEGAL
I'""! g_.~ ~*& Z ,_-: Y. F" "~ IL_ Z -ii- "'r" "~" F F~ ~-,a "~: ~'~ ~-~ ~: F~
/
E:,EPRRTFJENT C HIERLTH RND ENVIRONHENTRL.. 9TECTZON
264-4728
PERHIT NO. ( 8~:8825 ;, DATE OF I~%UE
:.r.::+:~: L..Ifl~NZHG - DUE TO CHRNGZNG REQLIZRE;HEHT~ TFIZ~ Pr~'.]NTOUT i',lR'¢ NOT E:E RN ENPfC:T :~:
:+::+:* COP'¢ OF THE ORZG~ONRL PER. HZT
RF'F'LICRNT DRVID L ~;!URID 2;R.R BOX ~.62:E~ R 9~5E~7 277-7:L6:L
LOCRI"I ON P~HISPER ING ~F'RUCE
LEGFIL L25B2 SK'¢ RRNCH ESTRTES LOT BIZE L~DDS~L~ S6!URRE FEET
T"?PE OF SOIL RE~BOR. E:TIOIq S~'BTEf"I IS: TRENCH
I"IRXtI%II"I NUhlBER OF' BEDROOHS = 4. SOIL RFITING ,:;S6! FT/BR)= 248
1"NE RE6!LIIRED SIZE OF TNE SOIL RE:SORPTION S'¢STEH IS:
THE LENGTH DZHENSZON Z~ THE LENGTN (ZN FEET.':' OF TFtE TRENCH OR DRRZNFZEL. D.
THE DEPTH OF R TRENCH OR PZT ZS TNE DZ:~TRNCE BETNEEN THE SURFRCE OF TNE
GROUND FIND TNE BOTTOhl OF THE EXCRYRTZON (ZN FEET).
THERE ZS NO %ET L4ZDTH FOR TRENCHES.
THE GRRVEL BEPTH ]:~ THE f'IZNZ['IUt"I DEPTH OF GRR',/EL BETP~E:EN THE OUTFRLL F'ZPE
RND THE BOTTOFI OF THE E~<CRVRTZON (;ZN FEET.':'.
BFICKF:'ZLLZNG OF RN"r' S'¢STEH PIZTHOUT FZNRL ZNSF'ECTZON FIND RPPRO',/FIL
DEF'RRThlENT 1.4ZLL BE :~UB.~ECT TO F'ROSECOTZON.
i'¢IZF,IZHUH DZSTRNC~ BETI4EEN R L4~LL RND FIN¥ ON--SZTE ~EI.,.I~GE DZ%F'O%RL LS'T'%TEt'I IS
%ELF1 FEET FOR R F'RZ',/FITE HELL.,~ OR
~t..~;¢ZI TO ~OO FEET FOR Ft F'UE:I..ZC t,.I~L.L E:'EPENDZNG UF'ON TNE T'¢F'E OP POE:LZC b.l~Lb.
1'"I~I"4Zt"IUH DZ%TRNCE FROH R F'~ZVRTE L4ELL TO R PRZ'¢WI"E ~EL4ER L:[NE ZS ~ FEET RNE:'
TO R COI'dHUNZT'¢ ~EL'.IER I_~r',]~ ZS ?5 FEE%
I.,IEELL LOG~ ¢~E REG~UZRED ¢INE:' t'IU~T BE RETMRNED TO TNE DEPFIRTHEr. J'f' I.,.IZTHZN
OF THE HELL COHF'LETZON.
OTNER RE~Z~LIZF~'.EHENTS I'dR'¢ ¢IF'PL'¢ -- ~F'ECZFZCFITZON% ~ND OON~TRUCTZOr.,I DZRG~¢It,'I% RR.E
RVRILRE:LE TO INSURE F'ROF'ER INSI'RLI_RTION
I CERTIFN" THFIT
&: I FIH FFIHIL. IRR HITH THE REQUI~;EI"IENTS FOR ON-SITE SEHER. S FiND HELLS RS SET
FORTFI B"r' THE HUNICIF'RLtT¥ OF RNCHORR~2E.
2: I ~,IILL INSTRLL THE S¥STEI'q IN FtCCORDRNCE P}ITH THE CODES.
~:: I UNDERSTRND TNRT THE ON-SITE SEP.IER S'¢STEH HI=tS,' RE6!UIRE E;NLI~R. QEfqENT IF THE
~:ESIDENCE IS~- -- .¢ ~ _ w62]"lODELED TO INCLLIDE ylOR~ THFIN 4 E:EDROOHS.
INS]PECTION HISTOR'¢ - SEPJER ~ 0 2;EI4ER. 2 0
1.4ELL IN~P 8 HELL LOG DFITE 8 DRILLER
GREA,ER ANCHORAGE AREA BOR ,dGI'I
Department of Environmental Quality
3330 C Street
Anchorage, Aiaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK: ' ' '
DISTANCE ~C~%~
FROM WELL MANUFACTURER MATERIAL
INSIDE LENGTH
INSIDE WIDTH ..... LIQUID DEPTH
NUMBER OF
COMPARTMENTS __
LIQUID CAPACITY/~¢¢[) GALLONS,
TOTAL L H
DISTANCE FROM WELL~-'~- FOUNDATION NEAREST LOT LINE .OF LINES (-~::~-~('
NUMBER OF LINES DISTANCE BETWEEN LINES _ TRENCH WIDTH ~. IN. TOTAL EFFEC-FIVE
ABSORPTION AREA (~/-~O SQ. F'F. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ~____IN. ABOVE TILE ~'/ IN.
TYPE '-~- ·, ~¢Yy,.].-~t,4~'~, CONSTRUCTION
BUILDING
FOUNDATION
CESSPOOL ____
APPROVED
NEAREST
LOT LINE
OTI4ER SOURCES
DISAPPROVED--
NEAREST SEPTIC
SEWER LINE , TANK
REMARKS
DEPTH
SEEPAGE
SYSFEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE: ,-,,,,~'"~'"'~
REMABKS:
DIAGRAM 01-- SYSTEM
DATE "~ } ?2"~PPROVED
G.A.A.B.
I..(:)-I' _ J., .E
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:}i:: I I..II",H:::'E:P:'/.E;Tf::II",II2 THI::IT 'THE OI",!-~; ]: TIE :~i;EI4E;F;'. ::i;"r':E;Tb':l¥1 I"ll::¥-r' I:;;'.E[;~I..IIr,;:[E [EI'.,II..F:II:[:(]~E:I',IE:F~T li::;' 'Till!:
[;:E?.~i;]:l}[!i]qC:E~ I!~; I:~:E:HO[)[_::I_ED TO :[MCL.LIDE I,]O[?.E: THFIH ]i:
I:::IF'F'L. :l: CFII",Ff' ...J)F:I~ (;:!I,.IF:I :[ I)
:1: ::!;~!!;t.,ll~::l:::, ~!, r ,.,,,,~ ........................................ ~ ....................................... I::: I::ITIE
QGRE
ANCHORAGE AREA BOF-'JGt.I
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SlF. PTIC TANK:
DISTANCE .....
FROM W~'~.E~
LEGAL DESCRIPTION ~'¢~" ,,~...C"
NUMBER OF
MATERIAL COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DE P-tH
_LIQUID CAPACITY /¢,-..~-g~-¢i GALLONS.
SEEPAGE Pit:
NUMBER OF PITS I DIAMETER _
LINING MATERIAL~O.~"(/~'C"C~/CRIB SIZE:
BUILDING FOUNDATION-:2~ , NEAREST LOT LINE __
OR WIDTH LENGTH DEPTH C'] !
DIAMETER DEPTH ~ / DISTANCE FROM: WE-L-b'
~?~O j~" TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) -(~-'/¢ ~'~ SQ. FT,
ADDITIONAL ABSORPTION
WELL: C?~/M ,'--/. ~6/~:~x-e.~Z-
TYPE , CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED ____ DISAPPROVED
DEPTH DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK __, SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTAL. LED BY:
PiPE MATERIAL~
LOT SLOPE:
RE'--MA R KS~
DATE I0-- /-~-'7~ APPROVED--~ '¢, ~'~t.14.¢¢~l.-'
G,A.A.B.
Form NO. EQ-031
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSI"EM -- APPLICATION AND PERMIT
TO BE INSTALLED BY
NOTE: TI'IlS PERMIT IS NOT V/ti-lB WITHOUT SOIL TEST
........ , DRAIN EIELD
SEPTIC TANK ~ ( SEEPAGE PIT
WELL. TO SEP'rlC TANK--~t~'~'~'~{ ., SEEPAGE PIT
CAST IRON INTO AND OUT OF SEPTIC TANK AND [NTO CRIB CROSSING GAP Of
EXCAVATION 5 F,':ET INTO UND]STURBEB SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPT]C TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL }FJ~ALTH
DEPARTMENT OF iLEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, to~a~ship, range) '
(.~ r,d I '~ ~.~ o, '2_
Location (addrese or directions)
Name ~_ ~ T( Telephone - Home Business
(b) Applicants ~I~;~L~~ ......... ~.~ ......
(~) Appliea~ is (cheek ona) Lending lust~tuCion [~ ~ Owner/bmU. de~ ~
(d) Lending Institution ~_._~J-O2~2u~-- ...................... Telepho.ne~ ........
Ad~d~ ~ss ...........
Address
elephone
(f) Mail the HAA to the following address: '
%~y3e o~f Residence
Single-Family ~[;~ Multi-Family
Number of Bedrooms ~_~_~
Other (describe)
Publlc~
Note: If community well system, must: have written confi~ation from the State
Department of Environmental Conservation attesting to the legality and status°
Onsite.~--~_ Public ~] Community ~] Holding Tank [~
Note: If community well system, must: have written confirmation from :he State
Department of Environmental Conservation attesting to ~he legality and status.
[Page 1 of 2]
5. .En~ineerix~ Firm Pr?_~vi_d.~ix~g._~I~n~pec_~tion~__~T.e_st~.~ File Search,_D_=a~ta and Information
As certified by my sea]. 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 hereiuo. I further verify tha%
based on the information obtained from the Municipality of Anchorage files and from my
investigation s~d inspection~ the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes~ ord:tuances~ and regula-
r:ions in effect on the date of this inspection°
Name of Fire
Address
Date '~7-- r~ ~- (~ ~/~ z~ '"'
_D_HE~_~_ A~roval
Approved fo~ /~-} bedrooms
Approved ~\/ Disapproved
Conditional
Terms of Conditional Approval
CA~fION
THE lf0NICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES tW~J~TI{ AUTIiOI~ITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH ii ABOVE BY AN INDEPENDENT PRO]?ESSI~-~' ENGINEER [LEGISTERED
IN 'i~ STATE OF ALASIQIo T~ DttEP DOES THIS AS A COURTESY TO PURCI5%SERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERII~IN FEDERAL AND STATE REQUIRE.-
MENTSo EMPLOYEES OF DHEF DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEPORE A
CERTIFICATE IS ISSUED. %~i~ MUNICIPALITY OF ANCHORAGE ~ NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN TUE PROFESSIONAL ENGINEER'S WORK°
(DHEP SEAL)
RR4/e~/D].8
[Page 2 of 2]
7~19-84
MUNiCIPALI1Y OF ANCHORAGE
DEPT, OF HEALTH &
EBIVIRONMENTAL pROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Classification A
Well Log P~esent (Y/N)
Total D~pth Cased to
Static Water Level
Casing H~ight Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sew~= Line
Cle ancut/Manhole
Wate~ Sample Collected By
Wate~ Sample Test Results
Ccn~ents
If A, B, c~ C, D.EoC. Approved(Y/N) ~
Date Completed Yield
Depth of G~outing.
Pump Set At
Sanitary S~al on Casing (.Y)~__
Depression A~ound Wellhead (Y/N).
; On AdjoiniJg Lots_
; On Adjoining Lots
To Nearest Public se~r
To Nearest Sewer Service Line on Lot
, __; Date
Date Installed [q9.%.. (6{~{_~___ S~ze _{0U~.~,/ ~-OD.~ NO. of C~mnts
StandDi~s (Y~) ~ ~ Air-t~.cht Caps (Y~) ~ Foundation Cleanout
~p=ession o~= Ta~ (Y~) ~( ~te ~st P~d _~- ~ ~
P~ing/Maintenan~ Con~a~ ~ File (Y~)~. _; fo~
Holding Ta~ High-Wate~ Ala~ (Y~)~/A ~a~y Holdi~ Tank Permit
Sep~ation Distan(~s ~ ~ptic~olding Tank:
To Water-Supply ~11 .~~____ To Building F~ndation 6 '~
TO ~o~rty Li~ ~ To Dis~sal Field ~ J~ z
Tc ~ter Main/Se~vi~ Li~ _L~ TO S~e~, Pond, ~e, ~ Major D~aina~
Counts
[Page 1 of 2] 2=15-84
Soils Rating in Absorption Strata ~[ O ,~/~¢~ Ty~e of System ~sign ~
Date Installed ~97~. (~Q~ ~ng~ of Field ~ ~
Wldth of Field 1~ ~u~ , U~ ) ~p~ of Fleld~~i.
Squ~e Feet of ~sor~io~$~: 0 5e~:~ Stan~i~s ~esent (Y~)
~pression ove= Field (Y~) ~[ ~te of ~st A~a~ ~st 7-%0~%
Results of ~st Adequa~ ~st ,~O~c~ ~ l ~
Separation Distan~ f=~ ~sorp~ion Field:
To ~te~-Supply ~11 ~ ~ ~ To ~o~rty Li~ ~ O ~
To Building Foundation ~ ~O ' To Existing or ~ndo~d System
Lot ~,/~ ; ~ Adjoining ~ts .~ O ~
To Wate~ Main/~vi~ Line ~ w% To ~t~(if pre~nt) ~,/~
To St~e~ond~ke/~ Majo~ ~aina~ C~se ~/~
To ~i~way, Parki~ ~ea, ~ Vehicle Stora~ ~ea ~ O/~
Comments
D. Lira STArIO 4/A
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
W~ets MOA
** Check Permitted Bedroom Rating A~ainst HAA Request
I certify that I have checked, verified, or confc~med to all MOA HAA Guideli
[Page 2 of 2]
on the date of this inspection.
KBi/dS/s .5,~C~.L
Date
MOA No.
in effect
2-15-84
APPLIr ~NT FILLS: OUT UPPER HA' ' ONLY
· . Phone
MaillngAddre~s ', ?', ~ /~ i'i ' ~j', ,~%~ ~,{ ,, -. , 'r /-')~
Buyer (,~- , '[ I_
Address ~ ~ ) ' '~, t' )l 1~ 1 I, ~ kL ~,,, ~, ~, zmpooae ~ ( ..; ~ ('-,~
Lending Institution ~ L ,~ i ,.. ~ ~-~ x ~.% , ~-~r~.V_ ~ ~Xx,..~ Phone
RealyCo.&A~nt~' ~/~7~- ~::(: ', t"r !, '~x , ;:~ ~ -"1 ;..)~ Phone
Address, ~, F t~.x~ r' [ -~ ~ , ..~ ,- ~' ~:-..,~ ZipCode' ~: ~ ~.'-~ ; // .~'1~..~
8treetkocatI~ ~:~ {r, L),.).~X W ~ ,~, ,t-~, ~;'.~ ~ ','~ '~,
~Multlple Family No. ol Bedroon~s
Time Time Time Time
Inspeolor Inspector Inspector Insp~,lor
Field Notes:
/t-~ ~
(~. ) CONDITIONAL APPROVAL'
Soils Rating Dale Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size