HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 21A-1Onsite File
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Municipality of Anchorage n
On -Site Water and Wastewater Section • (907) 343-7904 JAN 2 6 1 of 1
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211319
PID Number: 020-411-31
Dwelling: ❑ Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0011 Upgrade
Name
Rebecca Judd
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site
Site Address
6401 Italy Circle
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GP D/S F
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft_
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Paradise Valley
B4 L21A-1
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
I
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
0
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100.4
n/a
n/a
n/a
25'+
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
100'+
n/a
n/a
n/a
Material
Number of compartments
Lot Line
5'+
n/a
n/a
n/a
NA
HDPE
2
Foundation
12.2
n/a
n/a
n/a
LIFT STATION
Manufacturer
Capacity
Remarks Tank Replace Only
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank E /3034 Tank to 3034
( ) drainfield
Northern Excavation & Construction
Drainfield (E) CO/MT3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 1044.0 ft
Inspection vt 8/1/2022
8/1/2022
Location and description
3`d
2nd
41h
Bottom House Trim @ A
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
DateC:•••.,
*:49
seven annome
Septic System
Approved
Date �2 /0 2�
•, CE 8148 ,•�p7,,
'• 2024.01.22.
Note: this approval does not include well permit requirements.
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PANNONE ENG SVC LLC (C.I. 1088)
P.O. HOX 1807 PALtM, AK 99645
PHONE (907) 745-8200 FAX (907 745-8201
qF....
p' q�.
* '9� .
"fi3erei, an
CE 8149...,ERMIT
'
20 4.01.22,
REVISIONS
DATE
1/22/2024
RECORD DRAWING
PARADISE VALLEY B4 L21 A-1
REBECCA JUDD
6401 ITALY CIRCLE
ANCHORAGE, AK
SCALE
1" = so'
DRAWN
ACP
P.I.D..... NO
020-411-31
CHECKED
SRP
SITE PLAN
P N0.
OSP211319
SHEET
1 OF X
CURVE DATA
R=50.00'
L=93.74'
0=107.25'16"
LOT 10
39,459 SQ.FT
I _
O �l ifI LOT 11 T- """"�-''�_ _ 1 DETAIL: HOUSING FOOTPRINT
/ 19,019 SQ.FT.
T
/ A\n N76 I
05' (Ri _ FIREWOOD LOT 20 1
g0•
W 1.1' FROM STORAGE 15,080 SQ.FT.
� BDNY
DECK
ONE G I �,\
HOUSE V O\v
0.8' FROM
SHED BDNY PAP aQ�
-.
13.5'X8.2' \ �v G�,
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r1 1,-STAIRSAli 7', ` 1 SCALE: 1 = 20
FLOWER_' s�
=W GARDEN
�v N ROCK
368, GARDEN
DECK
40' 20' 0'
1'=40'
40'
,o
TWO-STORY
HOUSE
LOT 33
40,960 SQ.FT
.gam-'--�.- qY
ROCK
q
GARDEN
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LOT 21 A-1
28,947 SQ.FT.
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�- 61
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LOT 23A-1 III
33,094 SQ.FT. 1
I
1
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SURVEYOR CERTIFICATE
I HEREBY CERTIFY THAT I HAVE PERFORMED AN AS -BUILT
SURVEY ON THE PROPERTY SHOWN HEREON AND THE
IMPROVEMENTS EXIST AS SHOWN. FIELD SURVEY: 7/31/23
TAYLOR L. DOSCH, PLS 189892
OWNER, BLUE ARROW SURVEYS, LLC
8 /7 /2023
of Al...4
j c,�Q:.
*:49TM ..:*�rl
..:. ..............
Taylor L. Dosch j
r `� • No. 189892 • ���
AMW
8/7/23
P�'OfESSIONP���-WO-O
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ELECTRIC TRANSFORMER BOX
TELEPHONE PEDESTAL
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SANITARY SEWER STAND PIPE Q
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SANITARY SEWER MANHOLE m
LOT BOUNDARY >°
- - - - - -
- ADJACENT LOT BOUNDARY o
-------------
10, UTILITY EASEMENT a
-----
CENTERLINE
— - -
— EDGE OF PAVEMENT a
EDGE OF ROCK GARDEN N
-------------------------
GRAVEL EDGE
-------------
DECK/STAIRS
CHAINLINK FENCE W
WOODEN FENCE D
BUILDING W
NOTES
1. RECORD DATA SHOWN HEREON IS PER PLAT 94-157,
ANCHORAGE RECORDING DISTRICT.
2. THIS SURVEY WAS CONDUCTED WITHOUT THE BENEFIT OF
A TITLE REPORT. ADDITIONAL EASEMENTS MAY EXIST
THAT ARE NOT SHOWN HEREON.
3. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE
THE EXISTENCE OF EASEMENTS, COVENANTS, OR
RESTRICTIONS WHICH DO NOT APPEAR ON THE
RECORDED SUBDIVISION. THIS AS -BUILT SURVEY SHOULD
NOT BE USED FOR CONSTRUCTION.
4. THIS SURVEY IS IN ACCORDANCE WITH ASPLS MORTGAGE
SURVEY STANDARDS.
5. THIS SURVEY IS NOT A BOUNDARY SURVEY AND IS
SUBJECT TO ANY INACCURACIES A BOUNDARY SURVEY
MAY DISCLOSE.
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Community Development Department xis ` 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. 020-411 -V 5i
Property owner(s) Rebecca Judd
Mailing address
Site address 6401 Italy Circle
Day phone
Legal description (Sub'd., Block & Lot) Paradise Valley Block 4 Lot 21A-1
Legal description (Township, Range & Section)
Lot Size 28,947 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Qx all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
X❑
(w/wo ADU)
Septic Tank
X❑
Upgrade X❑
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: AZZ5, Waiver Fees:
Date of Payment: 7 -30 20.2 1 Date of Payment:
Receipt Number: 0948,2C. Receipt Number:
Permit No. OSP Z 1131 9� Waiver No.
Permit App_:- : ,�.,:c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211319, Deb Wockenfuss, 08/06/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211319, Deb Wockenfuss, 08/06/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211319, Deb Wockenfuss, 08/06/21
· ' ~ MUb~ICIPALh ~ OF ANcHORAo~?
~': MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH
', ;~-~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION[NVI2ONM~N?AL
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street-Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION ~EP_ORT
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
, .?
· ] Well . I Dwelling PERMIT NO,
I DISTANCE TO:
I-- ~ J Manufacturer Mater al No. of comp~ments
~ I tJAJc lio~ Ac E-
m ILiq. capacitv in gallons J IF HOMEMADE length
~ J DISTANCE TO: jWell Dwelling PERMIT NO.
~- ~ Manufacturer Material Liquid capacity in gallons
~Z J DISTANCE TO: I IOJ~J~
Distance b.et~en lines
~_Z~""J u. ~ J No. of lines<[ I . ~ . . JJ Lenath~,, of each./.7., line~ TotaIMateriallect~.~f~ Ii neSbeneath tile Trench wi.~l~, I inches Tote I ef ~v/e a~ ~:~ ~b~ ~p' tror~.a~
~ Length Width ~(~' inches PERMIT N~&
~ I- Top or tde to flmsh grade ~L~ ~ Depth
co -- DISTANCE TO: Building foundation Nearest lot line
~ I Class~o~ ~ U ~ ~ Depth Driller Distance to lot line PERMIT NO~J 1~
~ DiSTANCE'~TO: Building foundation Absorption area(s)
Sewer line Septic tank
OTHER
PIPE MATERIALS
P 303+
SOIL TEST RATING
INSTALLER
'T ~ i4 ,ex 84,...
REMARKS
DATE
LEGAL
Date' Dri!ledl ~- 27-~z,
Static Water Level
feet
Gallons Per Minute
Draw Down N/^ feet
Type Material Drilledl
Total Feet of Casin~
0 ~eet tO 17 ~sna. ~,rnveT.
120 feet to 220 Crsve]~ c]nv
He'-f%~ Dr--.~l-:i-i-r~ ............................................................ -~ .......................
S.R.A. Box 155~ H
Anchorage, Alaska
"CIP ~LITY OF ANCHOP~GB
.PT. OF HEALTH &
,~,~AsNTAL pROTECTIOJ~
NOV
RECEIVED
DEF'RRTMENT lql= ~4:~, .r,, .'- ...............
8';'~ L tS,'TF'.EET., RNCHORFIGE., RI';: L=.'9.50:L
264-472:3
F'ERM 11' NO:
[:,RTE I ..... UE[.:
~.J 4,. ,.L b,. ,:, ~
RPPLZCRNT:
RDDRESS:
CONTRCT PHONE:
[..EGRL DESCRZP:
LOT SZZE:
MRX BEDROOMS:
COLIN SZYMRNSKI
5ii E. 45TH
8NCHOR8GE, RK 9950~
56i-223~
SI";BD i ',,,' I S:; I ON: PRRRD I SE VRLLE~r'
SECTION: J..± TOWN'-:;HIP:
17975 ,'.:SL::L FT. OR RCRES>
3:
LO]': 2±
RRNGE: 2:1.4
BLOLK. 4
LISTED BEI...OW FIRE THE OF'TIONS Ff',,,'FIILFIE:LE TO YOU IN DESIGNING '¢OUR SEPTIC
::,~.:TEII. CHOOSE THE OPTION ]-HFt'T' BEST FITS '¢OUR SITE.
DEPTH TO PIPE BOTTOM <FT. >
GRRVEL DEPTH '::FT. )
TOTAL DEPTH (FT. ::'
GRR',,"EL HIDTH (FT ::'
GRR","E1....L.ENGTH '::FI'. )
GRFtVEL 'v'OI"_[JME ':: CI"J. '¢[.')S.
'I"Rt'.,IK SIZE (GRL. S)
SOt[ RRTING (SLq. F'F. ,-."BR::,
::L., 000. 0 .'+.':~':1 ~"¢, - i., 000, 0 :+:* i., 000, 0
250 t ~3------ ;22-:::3 250
...... UNS ::NOT
:+:* GRFf,/EI".. i EH]iTH /::. ,'5 :'T. ~rE:!..IRE:~ M..LTIF' , EXCEEDING ,'._, FT.
** TFtNK M[..IST HFIVE FIT L. EFIS]" THO COMPRRTMENTS
I CERTIFhJ THRT.
ERCH)
I Rl'd FRMIL. IFtR WI]-FI "FHE: REQUIREME:.NTS F:'OR ON-SITE SEWERS RNE:, WELLS RS SET
FORTH B"r' 'THEE MUNICIF'RLIT"r' OF F~NCHORFIGE <MOB) RND THEE .STFITEE OF FILRSKR.
2. I WIL. L tNSTRL. L THE S'.,.'STE]"i-I'N RCC:ORDRNCE WiTH RLL MOB CODES RND REGULRTIONS.,
RND tN COMPLIFINCE WITH THE ]:,ESIGN CRITEF.!IR 'OF' THIS PERMIT.
L3:. I WILL RDHERE TO RI._[_ MOFI .FIN[:, S'I"RTE OF BL. RSKFI REQUIREMENTS FOR THE SET BRCK
DISTRNCES FROM RN"r' E::'::ISTING WEL.[ .... I,.IFISU, TE].,.IRTER DISF'OSRL S'¢STEM OR F'UBLIC
SEWERRGE S'T'STEM ON THIS OR RN'T' RDJI'~CENT OR NERRB"r' LOT.
4.. I UNDERSTRND THRT THIS PERMIT IS VRLID FOR R MRXIMUM OF 2: 8E[:,RO0f"1S RND
RN'¢ ENI..F4RGEMENT HILL REQUIRE RN FI[:'[:'IFFIONF4L PERMIT.
IF R I_lET .::,T.'I~IUN tS INS"FFH_L.E[:, IN RN F. IF;.:EFI C:OVERED E:'¢ MOB E .ILE, IN3 CODES.,
THEN <1) RN EL. ECTF..:iC.:FIL PERMIT I::tN[:, INSF'EE:TION MUST E:E OBTFIINED.~ ,::2) RL=;-E:UILTS
P.IILL NOT BE HFFF._ /El. WITHOUT RN ELE'-TR. IEI~L INSPEC:"FION KEF_RT., RN[:, ,:'"'.':) THE
ALASKA IidlI ODmEDTAL CODTIAOL
~n§ineerin§ § ~nuironmental StucJics
April 30, 1984
Department of Health &
Environmental Protection
825 L. Street
Anchorage, Alaska 99501
Dear John:
As per' our discussion last week, I am writing to request a permanent
draina e easement situated on Lot 21, Block 4 of the Paradzse Valley
Subdivision. This particular easement, shown on the ac¢,ompanylng lot
~e 20 foot wide easement situated betwee . Y ,
as can be seen in the photographs, is well above p~reet grade. In
addition, there are several mature trees growing/in the easement area.
~e Cul de Sac, of Italy Circle drains easterly"to Finland Court which
is approximately 50 feet lower than the street' grade of lot 21, block 4,
Paradise Valley. ~e easement, which was p~'~tted in 1970 was apparently
part of a paper platt of the subdivision..~"
The variance, if granted, will allow th~ lot to be developed with a
three bedroom septic system and be ab.I~ to meet the minimum 100 foot
distances between neighboring system~. A copy of the perc test is
attached. Without the variance, g~e area available to site a septic
system is insufficient for a 3 b~room system.
In our opinion, based on an examination of the soils and a physical
inspection of the topograph~.~ there is no technical basis for the
existence of the easement../ ~e cost of removing the easement is
substantial, estimated a~/'~2,100 for technical drawings, physical
surveys and permits. ~e t~me est,.mate for remov ng the easement under
ideal circumstances is?'six week to 2 months. In our opinion, since
there ~s no technzca~' reason for this easement, the cost and time
necessary for removal of the easement is an undue burden for our clients
and penalizes the~/for a mistake made in plotting.
./
/ Sincerely,
,,'" 'PhD, PE
1200 LUcst 33r(l Aucn,¢, Suite B · Anchora§~:, AlasJid 99503 · (907) 276-1361
ALASK .iUIROrlmeI1TAL COllTROL Sel, ulCe$, I[1C.
~nqineerincI [ ~nuiro~mentat ~tudies
May 17, 1984
Robbie Robinson
Municipality of Anchorage
Department of Health and Environmental Protection
825 L Street
Anchorage, Alaska 99501
Dear Mr. Robinson:
Ron and Kathy Olsen have asked me to write this letter to you
requesting approval to construct a second on-site sewer system
on their lot
their first on-sit
An initial request for a waiver of distance to 95 feet from a
well to an on-site sewer system was denied by the state.
Approval of this waiver would have provided adequate room for
two sewer systems. At this time, the location of neighboring
wells, and the proposed location of the Olsen's well on lot 21
leaves only a small area on the lot that can be used for an
on-site sewer system.
A permit has been issued by the Municipality of Anchorage to
buld an on-site sewer system on the lot. The only design
option that will fit in the allowable area is a trench system.
The permit calls for a trench length of 38 feet, with a gravel
depth of 10 feet.
In the event of a partial failure of this sewer system there
appears to be at least enough room for 40 additional trench to
up-grade the system, depending upon the soils. If however,
the system totally fails and a new system is required, it
appears that a new system the same size could be placed a
minimum distance of 10 feet from the old system, while current
practice would require a separation of two (2) times the
gravel depth of the system, which in this case would be 20
feet.
It should also be pointed out that to maintain this 10 foot
separation between systems, a waiver will have to be granted
to build a sewer system 5 feet from a lot line.
The accompanying drawing shows the Olsen's lot and possible
arrangements for sewer systems using the permit design.
1200 LUcst 33r,J /~ugnu¢. Suite [~,/~nchorr~§¢. Alosk~ 99503'(907} 561-50z10
In conclusion:
The Olsen's have a permit to construct an on-site sewer
system. Their lot provides an area large enough to construct
this system, per the requirements of the permit. There is
also enough area to up-grade in the event of a partial failure
of the first system.
If the system totally fails and needs replacing, there is not
enough area to place a new system in keeping with the current
practice of 2 times the gravel depth of separation distance.
A new system, the same size as the old system could be placed
with a minimum separation of 10 feet from the old system.
At this time, we request that the Olsen's be allowed to build
a sewer system 5 feet from their lot line. We also request
that, if soil conditions allow, the Olsen's be allowed to
build a replacement system with a minimum of 10 feet of
separation from the old system, regardless of what the current
practice requires or what the Municipality regulations may
require in the future.
Approved By:
C. R®id, Jr. / ,?
No. 22~51.1= ..'~ ,~-~;
Sincerely,
Alan Donner
civil Engineer
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
~?¥o/~o
PERCOLATION
TEST
SLOPE
I-I~
I
I'lll
DATE PERFORMED: q --/O -- 4~"
Block ~/ ~ 2t
SITE PLAN
10
11
12
13
14
15
16
17
18
20
WAS GROUND WATER NC}
ENCOUNTERED? .. IS.
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE t~3, ~'~ (minutes/inch)
' TES]' RUN Bi=TWE~' .~.~.~, FT AND ~'~ AFT
72-008 (6/79)
72-025 (ReW 1/91} Front MOA#21
~,ou s! e§~Joqou¥ ~o ~llledlolunlAl eqj. 'penss~ s, eTeoyllJeo ~ e~ojeq ~;~p. ez,~l~Ue ,o sUO!ioe'd~ai
lou op SHHQ jo see~oldU~a ;.s~,~e~e, nbe, e;ms pue le~eP~,~ u e~eo ~s ;es o;,ep, o u suoqm, iTsurBulpue ~leqT pu~
seu~oq ;o s~eseqo~n~ pL~se~noo e se SiLl; seop SHHa eq±.'e~s~ ¥ ;o e~,m,S eq~, u pe~els oe~ ~eeu oue euo
3uepuedepu! ue ~q e~oqe, s~qdmB~d Ul ue^!§ suop, eluese~de~ eq~, uodn XlUO pes~q se~,eoy!l~eO le^oJddv.
dot q), eeH sen'ss~, ~s,,~,:'(~'N~l~a),~ ~.~,se°'~ueg~ ., ,u~mn'H pue. 'ql eeH ;o ;ueu~u~dea e§e~oqouv ;o ~1 ed o un, eqj.
¢'_...,,x[x.v
Block
%~ Lot 21, i 4
A. W~K~ DATA
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type R Ps i ~ ~n~- ! ~I[A, B, or C, attach ADEC letter.
Log present(Y/N) Yes
Total depth 388 '
Sanitary seal (Y/N) Yes
Parcel I.D.
Date completed
Cased to 22 o '
Wires properly protected (Y/N)
ADEC water system number
6/27/84 Driller Ref~-,y 1-)ri 11 ing
Casing height ~. 5,
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
6,/77,/q ]
244 '
4 GPM
AT INSPECTION
~/?/9]
249 '
g.p.m. 5 GPM g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 100 '
Absorption field on lot 103 '
Public sewer main _None
Public sewer service line None
; On adjacent lots 100' +
; On adjacent lots ] 0 ?, '
Public sewer manhole/cleanout None
Petroleum tank None
WATER SAMPLE RESULTS:
Coliform
Date of sample: 3/2/91
Nitrate
0
"::~ ~ (~2 Other bacteria
Collected by: Mountain Enqineerinq
B. SEPTIC/HOLDING TANK DATA
Date installed q,l~?/8z~ Tank size 1,000 Gallon Compartments 2
Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression (Y/N) No
High water alarm (Y/N) N/A Alarm tested (Y/N) N/A
Date of pumping 6/21/90
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
On adjacent lots 100' + Foundation 1 ] '
Absorption field 5 ' Water main/service line None
Well(s) on lot 100 '
To property line GT 10 '
Surface water/drainage
72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed None
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
9/22/84
Soil rating 250 FT2/BR System type Trench
Gravel thickness 10 ' Total depth 14 '
Cleanouts present (Y/N) Yes
Date of adequacy test 3/2/91
for 3
No If yes, give date
Date installed
Length 44' Width 36"
Total absorption area 880 FT2
Depression over field (Y/N) No
Results (pass/fail) Passed
Peroxide treatment (past 12 months) (Y/N)
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 103'
To building foundation
On adjacent lots 46 '
Surface water Nc~n
Curtain drain None
On adjacent lots 1 ~ ~) i + Property line
To existing or abandoned system on lot
Cutbank 2 0 ' Water main/service line
Driveway, parking/vehicle storage area 2
5' Per As-Built
None
None
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this~jnspection
Signature
Engineer's Name Mark Pearson
Date 4/1/91
HAA Fees
Date of Payment /-~ - ('~- ~'~' f.
Receipt Number ~.~._~ ~,/'(~ ~ ~(-~,~.
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR N~..~LTH AUTHORITY APPROVAL CERTIFICATE
i. General Information
Application Date
(a) Legal Description (include lot, block, subdivision,
Location (address or directions)
4pplteants ~dro, s
section, township, range)
Telephone - Home Business
(c) Applicant is (check one) Lending Institution
Buyer ~;. Other ~ (explain);
(d) Lending Ins !t:utio .
Address :' ' /~)0/
(e) Real Estate CO. & Agent
Telephone
Address
(f)
Telephone
Mail the HAA to the following address:
2. Type of Residence
Multi-Family~
Other (describe)
3. Water Supply
Individual Well~ Community~-~ Public~--~
Note: If community well system~ must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
0nsite~ Public ~-~ Community ~-~ Holding Tank ~-~
Note: ~f community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
Se
En~ineerin8 Firm Providin~ 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 regula-
tions in effect on the date of this inspection.
Name of Firm .~~ ,~ ~-/~.- Telephone
/
Address /Zz~) /~ ,~,~zfff/ ~<7~~/--- ~ /~~~'('~ 4/~_._~-~::~
Date
DHEP Approval Y~ //No. 22~I-~
Approved for~/~¢)bedroomSDisapproved By A-~ Condition~
Approved ,~~ ~ __
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
Well Classification P~I ~
Well Log P~esent _~/N)
Total Depth. ~ / Cased to
Static Water Level 7--~ //
Casing Height Above Ground
Separation Distances f~om Well:
To Septic/Holding Tank on Lot /
To Nearest Edge of AbsorDtion Field on Lot
To Nearest Public Sewe~ Line
· ~lClPALI~' OF
'~- D~pi OF HEAL!H &
M~ICIP~I~ OF ~C~GE (M~)
H~ A~O~TY ~PROV~ (~)
C~CKLI~ - FEBRU~Y 1984
Legal Description:
I984
k..'LEIVED
~ ; On Adjoining Lots ~-/¢~ ~
/~)~ ' ~;"On Adjoining Lots ¢ JO0 /v¥
C leanout/Manhole ./~//~
Water Sample Collected By
Water Sample Test P~sults
C c~ ¢~t~ n t s
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~//,~- ,.
B. SEPTIC/HOLDING TANK DATA
Standpipes~) Air-tight Caps ~1)
Depression ove~ Tank (Y~ Date Last Pumped
No. of Compartamnts ~
Foundation Cleanout~N)
Pumping/Maintenance Contract on File (Y/N) /P~-; for ~/~
Holding Tank High-Wate~ Alarm (Y/N) /~//~ Temporary Holding Tank ~r~t (Y~)
Sep~ation Distance ~ ~ptic~oldigg~nk:
To Water-Supply ~11 /DO/~4~ ..~To ~ilding F~ndation //
To ~o~rty Li~ ~7 / To Dis~sal Field
To ~ter Main/Servi~ Line ~ To S~e~, Pond, ~e, ~ ~jor ~aina~
Cour~ ~ /~0 ~
Receipt ~ 30~ q
Date Paid: ~
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
~ Square Feet of Absorption A~ea ~f~)
~-~ ~ Type of System Design
Length of Field I I
Depth of Field
Gravel Bed Thickness i
Standpipes P~esen
Depression over Field (Y~ Date of Last Adequacy Test
Results of Last Adequacy Test AJ /;~--
Separation Distance from Absorption Field:
To Water-Supply Well /~)-~ / ~ To P~operty Line, ·
To Building Foundation ~-I / To Existing or Abandoned System cn
Lot ~U ~-~ ; On Adjoining Lots ~f~)/
To Water Main/Be=vice Line ~ To Cutbank( if present) /d//%
To Stream/Pond/Lake/c~ Major Drainage Course ~ ! O~/
To DEiveway, Pa~king A~ea, or Vehicle,/~S~orage A~ea ?~ ~--~ ~
Co~ents ~- j4~ )~E~ J~7~ ~,j~'p~__~ . ////__~'/~-' ~;W~
' / ,
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
imensions
~ ~a~.ss (Y/N) ~' i
/--_ I./ Vent i( 7~)
~ Cycles du~ing Adequacy Test. ~ets MOA
Electrical Codes (Y/NJ
Con~nts /
Check Permitted Bedroom Ratin~ Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA GuiD~J~ines in effect
on the date of this inspection.
2-15-84