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HomeMy WebLinkAboutPARKS ACRES LTS 1 & 2 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: osp 1910907 PID Number: 05117145 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name Morrison ABSORPTION FIELD ❑ Deep Trench ❑E Wide Trench ❑ Bed ❑ Mound Site Address 19437 Inlet View ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.45 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.5 Ft. Gravel depth beneath pipe 4/4.5 Ft. Subdivision Block Lot Parks Acres Lts 1 &2 Fill added above original grade 1.9 Ft. Gravel length 50/55 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 1050 Ft, 2 10 Ft. Well +1 QO +100 - - +25 TANK 9Septic [:1S.T.E.P. El Holding ❑ Other Manufacturer Anchorage Capacity 1000 Gal. Surface Water + 100 + 100 - - Material Steel Number of compartments 2 Lot Line +5 +100 - - NA Foundation +10 +100 - - LIFT STATION Manufacturer no lift Capacity _ Gal. Remarks Old drainfield may not be used for a COSA Until cleanouts and Monitor Tubes are added. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 dTankrainfield ld 3034 Installer JR's(Tank) Guaranteed Svcs (drainfield) Drainfield 3034 Co/MT 3034 Inspector PES (Tank) Charles Balzarini (Field) BENCH MARK (Assumed elevation) 100 ft Inspection 1st 9/12/19 10/21/19 Location and description nd dates: 4`" btm siding at house corner 3`d 10/21/1 10/22/19 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp,`ZZtt�Nq i OF A�ll Conditional Approval: Date Q�• •S t TH •.* .. .... .. . :� .. r Septic S s App �--�� - -- - - - Date CHARLES G BALZARI.I r ..� CE -13854 - -� r ed ; ••r �`�F�F�PROFESSI4NP Note: this approval does not include well permit requirements. l (Rev 05/02/18) SWING TIES A B EXISTING C 38.9 11.9 TANK CO WELL D 28.4 17.3 TANK CO E 27.3 20.4 ATCO F 28.2 21.5 ATCO DRIVEWAY G 29 22.8 DIVERTER H 32.8 63 SPLITTER 1 37.9 62.4 CO 1 73.2 88.8 MT K 86.4 99.2 CO L 43.1 76.4 CO 3 BR M 45.2 78 MT HOME N 88.8 106.9 MT BM 0 90.9 109 CO E NEW 1000 GAL STEEL TANK DIVERTER LEGEND o CLEANOUT MONITOR TUBE ® TEST HOLE L 49 TH 100' WELL RADIUS CHARLES G BALZARINf / 6' CE-13854Aw •.����1 �PROFESs*0� -'.,� DECK Q `FCO \_ NEW CO FLOW SPLITTER (2) 5X50X4' EFF DRAINFIELDS APPROX. LOCATION EXIST DRAINFIELD -+100.0' BTM SIDING MONITOR TUBE MONITOR TUBE 99'7 FILTER FABRIC 99.65 gg,2 FINISHED FIL R FABRIC INISHED GRADE GRADE 5.3' COVER 7.35' 97.8' 6.9' COVER ORIG. GRADE COVER ORIG. 1000 GAL TANK 93.6 93.8 91.8 INVERT 87 8A 1.8 INVERT 87.8 87.3 4"4 DISTRIBUTION PIPE 4"4 DISTRIBUTION PIPE 87.3 89.35 4.0' EFFECTIVE SEWER ROCK 4.5' EFFECTIVE SEWER ROCK SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED - -- -- --ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. - -- SCHEMATIC ELEVATION - SCALE: NTS LEGAL DESCRIPTION: PARKS ACRES LOTS 1&2 C&M ENGINEERING SERVICES OWNER: MORRISON DATE: 02/07/2 REV: DRAWN: CBJ REF: 907-854-5558 SEPTIC RECORD DRAWING MUNICIPALITY OFANCHORAGE On -Site Water & Wastewater Program poBox 1*ussn 47ooElmore Road an:ouraoc.Alaska vgo1y-6nun Phone: (eoDa4z-rno* Fax: (9oz)o43-7asr On -Site Wastewater Disposal System Permit Permit Number: DGP191097 Work Type: Septic Upgrade Tax Code Number: 05117145000 Site Legal Address: PARKS ACRES LT5 1 &7 Site Mailing Address: 19437 INLET VIEW DRIVE, {}hUgiak Owner: K8ORR|SONGARLAND C&LAURIE K Design Engineer: PANN[}NEENGINEERING SERVICES This permit isfor the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms 4119/2019 4/18/2020 c� c� Disposal Field 2 Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction shall beinaccordance 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 (1G/uACOD) 1 The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.G5,Provide notification bycalling (QO7)343-7AO4(24/7). 4� From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated Loprevent freezing Special Provisions: The tank shall be located no less than 5 ft from a loundation supporting a storage shed or similar structure having a total gross floor area of 600 sqft or less and having an eave height of 10 ft or less. Received By: v Issued By. - 91 Y' , 0 ' , Date: _71,6 MUNICIPALITY OF ANCHORAGE Community Development Department F 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. 051-171-45 Property owner(s) Garland & Laurie Morrison Mailing address 19437 Inlet View Drive Chugiak, AK 99567 Site address 19437 Inlet View Drive Day phone Legal description (Sub'd., Block & Lot) Park Acres L1 & L2 Legal description (Township, Range & Section) Lot Size 36,364 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) MR Septic Tank ❑X Upgrade nX (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of owner or authorized agent) Permit/Rush Fees: 2-2-5 Waiver Fees: Date of Payment: q 1 l I %I 9 Date of Payment: Receipt Number: oa i, 3A6 Receipt Number: Permit No. O cJ P I g 1 Uq1?_ Waiver No. Permit App_.:- :._..,:c: 341 ci Pannone Engineering ServiceS LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(@Panengak.com JULY 1, 2019 Subject: Park Acres Lot 1 and 2 Septic System Upgrade Permit Request Design Narrative This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed septic system will serve an existing three-bedroom (3) bedroom house. This lot and the surrounding lots are served by private wells. There are no wells within 100' of the proposed system. 1. Soils. Per 15.65.210 Exception, ten test hole logs and located surrounding this system. Numerous engineers and agencies have performed test holes in the area and similar soils were found in every hole. (closest 4 test hole logs are attached). Groundwater monitoring has been performed and the highest groundwater mark was at 14' below grade. There was no groundwater monitored to a depth of 16' in any of the other surrounding test hole logs. With a total depth of 10' the proposed system will maintain 4.0' separation to the highest groundwater reading. This test hole was performed by KND Engineering and was performed at the same relative elevation as the proposed system. Bedrock in the area is known to be deep in the area. The soils are typically 30-60 mpi with only a few test holes with faster percolation rates with. Based on the results of the surrounding percolation tests and known soil types in the area; an application rate of 0.45 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the east to the west in the area surrounding the septic system at approximately 0-1%. There are no steep slopes within 50' of the proposed system. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. 0 GARNET COURT = N Z ^ DECOMMISSION SEPTIC TANK E TH / PER CODE AND I (KND 2006) ~ INSTALL 10000 SEPTIC TANK (P). W/DCO AND DV AFTER CONNECT TO END OF EXISTING DRAIN FIELD AND END \ OF PROPOSED FIELDS NN / 3BR HOUSE r_ ___-� TH LOT 1 &2 DRAIN FIELD E ff (KND 2006).`Z .8 3o.a I WELL (E 108 l/ 124.7 M I z 255 , DRAIN FIELD E \ INSTALL FLOW SPLITTER P (2EA) 50LF x 5.0'W x 4.0'ED x 10.0'TD — INSTALL CO AND MT AT EACH END DRIVEWAY ' --�c\ 10' UTILITY EASEMENT j 4_ TELL E WW--� w DESIGN PARAMETERS DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM RESERVE SEPTIC SYSTEM ABBREVIATIONS NO. BEDROOM: 3(450 gpd) NO. BEDROOM: 3(450 gpd) TH TEST HOLE TANK SIZE: 1000g TANK SIZE: 10OOg (P) PROPOSED PERC RATE: 31-60 MPI PERC RATE: 31-60 MPI (E) EXISTING SOIL RATING: 0.45 GPD/SF SOIL RATING: 0.45 GPD/SF CO CLEAN OUT NO. AREA ROD: 1000 SF AREA ROD: 1000 SF RF: 0.50 MT MONITOR TUBE NO. RF: 0.50 ADJ AREA: 500 ADJ AREA: 500 TYP TYPICAL SYS. TYPE: SHALLOW TRENCH 4.0 ED SYS. TYPE: SHALLOW TRENCH 4.0' ED MIN LENGTH: 100 LF MIN LENGTH: 100 LF W WATER LINE/ USE: USE: WELL RADIUS (2EA)50LFx5.0'Wx4.0' E.D., 10.0' TD REMOVE AND REPLACE TOTAL AREA: 500 SF SS NEW SEPTIC NOTES: PAMONE EMG SVC, LLC ®4`�` ��®� �F A� Dote 7/3/2019 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 'C� 9s1�� PHONE (907) 272-8218 FAX (907) 272-8211 co --. .-v Sit �� DRAWN BY: 50' DRM 1.. ""P.I.D. NO PARK ACRES, LOTS 1 & 2 ® 051-171-45 GARLAND & LAURIE MORRISON r Steven "Pannone CE 8149 PERMIT No. 19437 INLET VIEW DRIVE q,-� OSPXXXXXX PLAN ANCHORAGE, AK 99567 ®PROFESS00 r She et �� 0� 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. SCOPE AND SPECIFICATIONS: 1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MOA COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND 1N ACCORDANCE WITH AMC 15.65 AND 15.55. 1.2. CONTRACTED WORK WILL BE IN COMPLIANCE WITH MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) DIVISION 10 & DIVISION 20 AS APPROPRIATE. 1.3. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM. DOCUMENT WELL 1.4. GROUNDWATER WAS ENCOUNTERED AT A DEPTH OF 14 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SURROUNDING SOIL TEST HOLES. IF AN APPA�WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. I.S. STRUCTURES DEPICTED ON THE SITC 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 t 1 " 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 SHALL FAMILIARIZE THEMSELVES WITH THE SITE CONDITIONS AND LOCATIONS OF ALL LOT LINES, EASEMENTS, WELLS (E & P), SEPTIC SYSTEMS (E & P) AND SHALL MEET MINIMUM SEPARATION DISTANCES OR AS NOTED. 3.2. 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. 3.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 3.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 3.5. 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. 3.6. 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. 3.7. 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. 3.8. 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 WILL BE PERFORMED IN ACCORDANCE WITH THE APPROVED 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: NOTES: n��T�T �7� �T /v T T `�� \ Date FOR CONSTRUCTION PANNONE ENG' SVC, LLL. d4 OF q� �tl 7 P.O. BOX 100217 ANCHORAGE, AK 99510 'C� • 4s �) X3/2019 DRAWN BY: PHONE (907) 272-8218 FAX (907) 272-8211Scale DRM ... . .. ..... P.I.D. NO PARK ACRES, LOTS 1 & 2 / 051-171-45 GARLAND & LAURIE MORRISONSteven R. Panno'e �r �s CE 8149 ���< o 19437 INLET VIEW DRIVE f c OSPXXXX PLAN ANCHORAGE, AK 99567 ��l1lFD0ssioya`�.. sheet 2 OF 3 —%f- - x. c— NJ °A ,res 045 r ',% ~.:,_ ~ 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 PHONE E~NEW Well Absorption area Dwelling DISTANCE TO: t O~'~ f- ~, Om /O Manufacturer ~ f Mat erial ~,~_~2,,~ ILiq- capacity in gallons I ......... ;. j~e length Width iww.' ./ Manufacturer I ' '~ Material [Well ¢ ~ Foundation ~ I Nearestlotline ~ No. of lines ~ ] Leogt~ of each line Total length of lines ~ Trench width ~ I ~1~ ~t ~1 ,hGinches Top oftileto finish grade 5 ' Material beneath tile 7~inches Tgpe of cri~ Crib diamomr Crib depth Well Building foundation Nearest lot line DISTANCE TO: U ' -- -~ Building~unda¢on Sewer line Septic tank [00 ~ DISTA~E ~u ~ '¢ NO. OFBEDROOMS PERMIT NO. No. of co~artments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO, Dista~.~et~i~we e. lines Total effective a~.~i~rea PERMIT NO. OTHER PiPE MATERIAL~ so,, TEST INSTALLER REMARKS Total effective absorption area PERMIT NO.~ Absorption area(s) DATE LEGAL 72-013 (1~(].'3/78) GREAT':,_ ANCHORAGE AREA Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE ~.. - . NUMBER OF FROM WELL ~'~.~/ MANUFACTURER'~J~ ~ C-{~"Fd~/V~IMATERIAL ('~}-v(~}/~.'~:~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY '7~:-~) GALLONS. SEEPAGE PIT: NUMBER OF PITS -- / DIAMETER _~-- OR WIDTH /~-/~, LENGTH//-// DEPTH LINING MATERIAL/--4~(~ BUILDING FOUNDATION~/ l, / CRIB SIZE: DIAMETER(~ _/~DEPTH DISTANCE FROM: WELL NEAREST LOT LINE :'~2~ / / TOTAL EFFECTIVE · ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION ~- CESSPOOl '- APPROVED_ DISAPPROVED CONSTRUCTION~ ~./~-:z,'~-~ ~.~, ~ DEPTH NEAREST SEPTIC LOT LINE ~ TANK OTHER SOURCES NEAREST SEWER LINE REMARKS. / DISTANCE FROM: SEEPAGE SYSTEM /~ / DISTANCES: ,~ ,b ~/~¢o INSTALLED BY: PIPE MATERIAl LOT SLOPE: REMARKS: Form PW-026 DIAGRAM OF SYSTEM g~¢~Ak'r~_~R ANCHORAGE AREA BOR~'~GH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT~~ ~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE. ~'~~-~ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT. SEPTIC TANK TO SEEPAGE PIt WALL--~/5/ SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FielD SEPTIC TANK. . SEEPAGE Pit TO RIVER, LAKE. STREAM. DIAGRAM OF SYSTEM , DRAIN FIELD , DRAIN FIELD / SEEPAGE PIT /~(~ ALSO CONSIDER AREA WELLS. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM T~REGULATIONS REGARDING iNSTALLATION. I CERT/~}T'~ WITH THE ~EQUIREMENTS OF GREA.B~RAGg~ ~ AREA BOROUGH ORD]NANC~ NO. 28-68 AND THAT THg ABOVB F'ERt,t I ]" I'.,!c. FtPI:::'LICFi!'.,IT ["lIKE !,.fILL. BUR SR [30X 7',:t.}:' CHUGIFII< L.OCFFt"IOF~ INLET VIEI,:I DR. L. EGFIL L.:l. & LE: PF:II;~:I<S RCRES Z,.."D LOT SIZE T"r'F:'E~ OF SOIL F:IB'.'E;ORE'q'I'ON 2?',"S'I"EM IS: TRENCH ,:$'.:J:~:L~31:j: E;C!IJI::II-;~:E: F'EEET I'"iFI;:':;Ii'"!UH I",ILIP'IE:E{R C)F E:E[:'ROOME]5 = E: ZOII_ RFIT!NG ,::'_E,C! F:T,."'E:I;i:)= ;2E;EI ]'HE REC!UIRE'.T:, SIZE OF THE '~CIZL 61E.':E;ORPTION"-':, ,'"--:,F.:.HF' i:Z: THE LENGTH [:, I MENS I ON I S THE L.EI',IG]"H: ,:: I N F'EE'T ::, OF' THE "r'RENCH OR DF?.I::I t NF:' I EL..[). THE [)EF'TH OF' t::I TRENC:H OR PIT IS THE' D t:STF:Ii'.,ICE BE!:TblEEf",I 'I"HE SLIF?.FF:!CE OF THE GROUI",I[:, Fff',l[) ]'HE BOTTOM OF THE: E'?,',CI::I',,,'F!]"ION TIdERE IE; NO ZE'T' NIl)TH FOR 'TRENCHE:S. THE GRFI",,'EL [:,Ef::"['H ZS THE MINIMUM [:,EPTH OF GRFPv'EI... BETt4EEI",t THE OLITFf:ff...L PIPE FIND THE BOTTO['I OF' THE E::':',L';:FI~,,,~I::IT I O?',t '.'.' 1' F'ERM ]: "1" RPF'L I E:FIN'I" HF'IE; THE RESF'ONE; ! E~ I L I T'¢ "r'o I NFCIRM TH" 'El [:,EF'F:IR"H'IE:NT [~,UF:: I NG 'THE . i NE;TF!L. Lf:IT I ON I NZPECT I ON'.:5 OF FIN'T' b. IEL. L2'; Ih[:,JRC:ENT 'T'O TH I S F'ROPERT'-r' FIN[' THE NLIMEFI-? ELF:' RESIE:,E'NZE:EI THF!'I" THE klE;LL 14!L.L E:FtCI-:::F)EL. LINC~i C.F: I"':iiq"r' E;"r'STEM t4:['r'HEE.IT F'II'.,!FIL II',ISF'ECTION RI'-,tE:, F4F'F'F:'O'v'FiL 8'¢ 'THIS [:,EF'F:IRTHEN'T' 14ILL E:EE SIJELJ'EEC:T TCi PI:;OE;EC.IT][:F, ,,, MINIMUH [:,IZTRI',ICIE E]ETb.!EE:N Ft !.,.IELL. FII',ID FIF,I"r' Lf",I-.:,;I FE. ........ ':i;E't.,-llq]iE DT':;Pq':::;tql z,""""r: ...... E ! I S "LO~:~ FEE]" FOR I:~ F[...1.:I-It.:. !-,.IELL..~ OR J_SE) TO :;:",::~:~ FEET FROM FI F'LIEfl...T ': 14ELL DEI:::'ENE:,:[NL]i LIF'O!',I THE-I'"r'l:::'E OF F'UEL TC I.,]IZLL.. O]"HEF~: I:~:E'E(;:¢J ]: REMENTS MFt'T' F:II PL'¢. FJPE '] I F' I CFIT I Cff',IE; FIN[) CIDNSTI~:UCTI C bI [:' :[ f:IGF.:FIi"I:?¢ FIRE: Ft'v'FtILFIE:I_E TO IIqZ, I..IF;;:EE F"F.' "'PFR I I',1::,1HLL.t. t' IUN. I CE:RTZF'¢ THR'T :!: I RM FFIHI'[..IFffR t.,I].'"FH THE REC!U.'[REHENTZ FOR O[',~--':E:2("['~i :SEI.,IERS FIN[:, !,.IE[..[...:!']; t-':lf~, SE'T FOR'FH E',"r' 'T'HE MUN I C l F:'fZtL. I T'¢ OF FINCHORFIEiE. 2: i 14I!.J.. INSTFILL. THE S'T"_'EITE!'"t l'N f:II.7:COR[)F:II',!CE I.,.tITH THE COl)ES. :~7:: I UN[:'EF.:STFIN[:' THFF[' THE OF,I-SITE :SEklER Z"r'STE:M M't=l"r' REQLtiF.".E ENL. FIF'.':GEZIEN-!- Z F: THE RES l DEf-,ICE I '.'~; REMODEl--ED TO I NC:LLJDE MORE "['HF!N ]: PERMIT NO. FtPPL. I CFINT LOCFtT I ON L. EGSL 279-251:t. ~S E Ib~l E F~-': F' E:'; F..: ~--'~ ][ -f' MIKE WILL. BUR, INLET VIEW DR. LT. i&LT. 2 F'RRKS FIE;RES S,.'"D SR. E:X. 747 CHUGIFtK LOT SIZE 688-]i:'~:6::t. 4.'Z<56~'1 S(;!I..IRRE FEET TYF'E OF z, UIL HE,..-.,UF..E, T1UN ,:,~.:,]EM ]_~': ]F, EN..N MFIXIMLIM NUME:ER OF BEDRC,:]MS =K/ E]OII.. F.:RT I NG < FTZE;R ) ]"HE I~'.Ef.-]!UIRED SIZE] OF THE SOIL FtBSORPTION SVSTEM IS: 26E1 [:,EF"-FH= :.:.1_ ~E~ L, El II'-.t,S T H = 4:~ ,S F.'. FI "-.-" E: R .... [:,E F"T'H = 7'HE LENGTH DIMENSION IS; THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIEL[:,. THE DEPTH OF FI TRENCH OR PI]" IS ]''HE [:,IL-.-;].'FtNCE BETWEEN "['PIE SUF..'FRCE OF ]"HE GROUND RND THE BO].'TOM OF THE EXCFIVFtTION (IN FEET). 'THERE IS NO SET 14IDTH FOR TRENCHES;. ].'HE GRFIVEL DEPTH 115 THE M INIMLIM [:,EPTH OF GRFf,/EL BETWEEN THE OI_I'I"FRI.._L PIPE RND THE F}"O'FTOM OF THE EXCR',,,'RTION (IN FEE]''). F' Ft £: 1<:: F~ 1..3 E: F" L F-I ~'-,t -IF' C~ F" T' ~ FI FHUF..H.~E PI_FINT MFtY BE IN_-.FMLLEE. FI]- t-HE PE"iRMITTEE]'"S OPTION SLtB,.TEI."YT TO ]"HE_' FOLLOW I NG COND I ]'' IONS: :i.. EITHER Ft CLFtSS I OR II NSF FIPPROVED PLFtNT MBY BE] INS]''RLLE[). R. Ft CONTINUOUS MFIINTENFINCE 8GREEMENT IS RE6!UIRED. IF FI MFtINTEI'-~FINCE RGREEMtENT IS NO].' KEPT CURRENT YOU MFtY E:E RE~..-.!UIRED TO ENI....FtRGE THE SOIL. FtE:SORPTION SYSTEM FtND,.."OR YOIJ MRY E:E SUE:JEX]T TO PROSECUTION. BRC'KFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RF'F'RO',/RL BY 'THIS; D, EF'RRTI"IENT WIL. L BE SUBJECT TO PROSECUTION. MINIMUM DISTFH'.JCE 8E:TWEEN R WELL FIND FtN"r' ON-SITE SEWRGE DISF'OSRL. SYSTEM IS :l()E'~ FEET FOR R PRIVRTE I,.IEI_L OR 26~E~ FEE].' FOR R PLIBLIC WELL OTHER REQUIREMENTS MRY RPPL"r'. SPECIFICRTIONS RND CONSTRLICTION DIRGRRMS FIRE: R",,'RILFtBL, E TO INSURE PROPER INSTRLLFtTION, I CER].'IF"¢ THR].' ::L: I FtM FRMILIFtR WITH THE REC-~UIREMENTS FOR ON-SITE SEWERS RN[:' WEt.tS FIS SET FORTH .F.,'"r' THE MI..IN I C I PR[_ I TY OF RNCHORFtGE. 2: I WILL INSTFtLL THE SYSTEM IN RCCORDRNC'E WITH 'THE CODES. 2:: I UNDERSTRND THFtT THE ON-SITE SEWER SYSTEM MFI"r' REQUIRE ENLRR(qEMENT IF ]'HE RESIDENCE IS REMO[:'ELE[:' TO INCLUDE MORE THRN :~: BEDROOMS. S I GNED: _._~_ ................. . FI P P L.. I)]: FI N T///? I K E l $ I L_ L. E' _ F.'. '. ..... 7 ,.,,,. ,..-, ._, .... _ I :.,.=,I_IE [ .' ..........' F'~F.:M ~ T N [:,EPRR'f ME. NI' '%$' HERLTH IRI'.4[:, Ei',l'v'I RONMEN]'Rt.:' pROTECTI ON 25±E~ E. TUDOR RD.., HNE:HORRGE., IRk:. (. 76::~:~¢2 .':, F~F'PL.):C:Ri'.4t' t"iZKE bilI...LE:~ :~:;R BOX 7"4.7 CHUGIRK L :iCR't'Z ON ~: NLET ',,,' I E[4 ---,--,- Lo'r -i'"r'F'b: OF' 2:;O:I;L. F:tBSORE:TICd",I ':'~;'¢S'f'Ei"t I:~;: TRENCH i'i¢4;,',;ZhiLti'4 t'..!L.IMBER OF BED, ROOMS =,.~L RR]'ZNG ('.E;i';! FT,.-"E:R)= THE RE(,:!IjiREL:' SIZE OF 'rile SOZL RBSORP't'):ON 2;k'S'T'EM L. ENGTH [:, 1 MEN~ t ON THE [:,EF'TH OF R TRENCH OR FiT I~ THE [:,t5;'(RNCE E:~'T'b]EEN THE SURFRCE OF THE THERE ]:~5 NO SET t.,.IIDTH ~OR TRENCHES. ~ % THE GRIg,/EL [:,EF'TH )~E; THE M:['.ItMLIhl [:,EPTH~:]F_~R,,¢EL E, ETb~EEN THE OLI'FFRL. L RND THE BOT]'OM OF THE E,qC:R,¢RT{ON (IN k ~_~'rHl~: ~:m E:LRSS Z OR Z Z NE;F RF'F*i~:O'CED ~'LRNT MR'¢ E:E ZN2;'I"RLL. EE:,. RGREEMEN'I' ]:2; 1'.40[F KEPT CURRENi~ ~O~1 I',1R'¢ ~:E RE~;!LIZREE:, TO ENLRRGE THE SOZI RE:E;ORF'T I ON 5'¢5'1'~M RNE:,,.'"OR '¢OU ~ W ~E:..TECT TO F'ROSECUT Z ON. ).F R OL. RSS Z S'¢E;TEM ZS LISED TH LENGTH Z2; 47. 8 FEE'F. ~P' Ft CLRSS Z Z 2;'¢E~"E:M Z:5 LISE[:, 'rH~ LENGTH ZS 60. 8 FEET. E:,EPIstR TMEN"I' [,~ :i1LL E:E SI..IE:.3'()]:T TO PRC~2;ECt~ITZ ON. / S'¢E;TEFI 2.0[¢ FEE'I' FOR R PR~,,,R'TE WE~L OR 2.80 F~ET F'O~. R FI...IE, LZC WELL. , .... iCRTZONS RNE:, C:ON~7i"RU~TZON [:,Z~RRM:~; RRE R',,,'RZLRE:LE TO ZNSORE PROF ER F' 1 i'.,i~;'I"¢tL.L_FI'i" ~ ON. I C'h_'l-.:t'l F"¢ 'I'I4FI"t ±: ~ RM H'Ri"IlLZRR btI'l"H THE REL-:!UIREMENT~; FOR ON-SITE ~.;E[4ERS lIND NELL5 RS ~;E"i" FORTH B'¢ THE MUNICIPI:ILZ-I"'¢ OF FINCHORFtGE. ;¢: I b-IiLL ):NS]"RLL THE S'¢STEM IN RCCOR[.',RNCE b. IITH THE CODES. :}::: i UNDERS'1¢~N[:' THRT I-HE ON-SITE SEWER '"~;'.¢$]'EM MR'¢ RE6!UIRE ENLRRGE:.MENT iF THE i-,~:E~;I[:,ENCE :[£5 REMI])DELE[:, TO INCLUDE MORE 'THRN 4 Ei:EI:)ROOi"IS. IRP~: L :[ CHv41 J',~i I.:::E b.!tLL6.. R ........ · :--"'0 .Er E .GEYJ~-,~c-~-HNICAL Er DEVEL.~,r-,/IENT CO. Russell Oyster 694-2774 Soils ~t Foundations Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Performed for: Name: r Legal Description: Depth (feet) SOIL LOG Maillng Address: Earl Ellis Co88-2280 Land Development Tel. NOo ' , ~ Sol1 Charactertst!c~ , 1 2 GroUnd water Encm~ntered: Proposed Installation: Comments: Yes No~ If yes, what depth.._~ Seepage Pit ~ Drain Fie~d Performed by: Date: J~ly 6~ 1977 Permit ~76392 Mr. Mike Wtllbur Star Route Box 747 Chugiak, Alaska 99567 Subject: Permit Expiration Dear Mro Willbur: A permit issued by this department for well and/or on-site sewer installation on Lot 1 and 2 Parks Acres Subdivision has expired since the issue date exceeds one (1) year. In the event you still plan to install the well and/or on-site sewer system, a new permit is required° The original soil test may be used to obtain a current pe~ito If the well has been drilled, a well log should be sent to this department to document the installation date. If you have any questions regarding the above matter, please do not hesitate to contact this office in,mediately at 279- 2511, extension 224 or 225. Sincerely, Les No Buchholz, R.So Sanitarian LNB.ljh ' January 3, 1978 Mike Willbu~ Star Route Box 747 Chugiakv Alaska 99567 Subject: Lot 1 and Lot 2 Parks Acres Subdivision Permit # 77716 A permit isSued by this department for well and/or sewer system has expired. 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 lo9 should be sent to this department to document the installation date. If there are any further questions, please oontact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT A. SHAFER June 5, 1986 CIVIL ENGINEER 694-29Z9 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Susan Oswalt REFERENCE: Lot I & 2; Park Acres Subdivision In December, 1985 you issued a Health Authority Approval (conditional) pending a depression around the well casing being filled and monitoring tubes on the absorption area being extended. With our inspection on June 5, 1986 the depression around the well casing had been adequately filled and the monitoring tubes had been extended. Request you issue a final HAA for the systems located on the referenced property. If we may be of further service, please contact us. cc: Darlene Nicolaysen RE/MAX OF EAGLE RIVER SRB 196X EAGLE RIVER, ALASKA 99577 by OOC Co. dba SULLIVAN WATER WELLS P.O. BOX 679272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION ,: - :...,. , .7~ ,=~-/:~.,,..~ DATE- Started Ended PE~IT NUMBER .(""[ . DEPTH OF WELL STATIC LEVEL OF WATER F'F. DRAW DOWN FT. GALS· PER HR ~:. t~, L; .<%, .m. ,?'~ /'~ KIND OF CASING .... ~c~ KIND OF FORMATION: From ( .~ Ft. to ~O% Ft. From ~.7 .,) Ft. to ,YT?~: Ft. From~ ? ]~,~ Ft. to-:~ ~.~ii~ 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. From Ft. to Ft. From Ft. to Ft. From. Ft. to___Ft. From__Ft. to___Ft. From Ft. to__Ft Lt. i~./d, ,:~/, ~)(~) eL?/:~:'LG From .__ Ft. to .~ /]'."J&~ 7'~3~ )~' From Ft. to From Ft. to From Ft. to p,,L.~.!cipALil~,r ~ DEPT' OF HE~ --to From ~ to From Fro m From From From From Ft Ft Ft. Ft, Ft Ft, Ft Ft. Ft. Ft. Ft. Ft. to Ft Ft. to Ft Ft. to Ft Ft. to Ft Ft. to Ft. Ft. to__Ft MISCL. INFORMATION: DRILLER'S NAME WATER WELL RECORD STATE O~ ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 6 Geo~hysicol Surveys Drilling Permit No, LOCATION OF WELL (Pleoee complete either la~ lb or lc.,) A.D.L. No. le.ll~oro.oh p~ivi,,o. Lot B,o,k ' TI '~'"'"' Sect,on Ne. To-.eh!,NO Rea. EmMeridian Ic.JJDISTA:NCE AND DIRECTION PROM ROAD INTERSECTIONS · 5.'OWNER OF WELL:' ."~ ' Street Address and Are~ Gl Well Locofion' .. ' · 2. WELL LOG · · - Feet Below : . . Surfoce ~ 4.' WELL DEPTH: (final) 5. DATE o~COMPLETiON 0 Threeded ~ Welded diam. In. fo ft. Depth Stickup ft. %~ .~/~ Set between ft. and ff. ~ · ,~ ~ Baok filling Grovel pack " D~p~' Ur ~, .... I0, STATIC WATER LEVEL: ~NVI~" ~ Above or ~ Below land surface Date V i~ ~ ft. after --hrs. pumping g.p.m. I~.GROUTING Well Grouted: ~ Yes ~ No Material: ~ Neat Cement ~ Other: 16. WATER WELL CONTRACTOR'S CERTIFICATION= 15. Wofer Tem.perefure o ~ F ~ C This/~We[I we~ drilled u~er~m~u~sd[clion~ ond this reporl is true to the be~o~my knowledge end bellef~ Authorized Representative Farm 02-WWR (H/81) Copy Distribuflo~: WHITE-Stole DGGS~ PtNK-Driller~ CANARY-Customer Tom Fink, Mayor / lunicipal ty Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196850 Anchorage, Alaska 99519-6650 January 8, 1990 Housing & Urban Development Disposition 701 C Street Box 64 Anchorage, Alaska 99513 Subject: Lot 1 Parks Acres Subdivision Permit #890206, PID #051-171-30 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" Lo'L Leg a ! ~;: Sub (::! :i. v i s :i, c)n: PARI.=::S ACREZS L.o'L: 1 B 1 oc k: '- Se,:::'L :i. on Lc)',':. Size :1.9489 (sq. !'t,, c:m acre!s~) M,.:'.',~x Bex::Ir'oc)m:~.:~ This :!: CE!:R"f'Li:i::'Y "I'HA'T.~ :!.,, :[ am ~am:i. l iar'. w:i,'Lh 't-..h~::~ r,*.:.~qu:[r,~.,:,m~e::.md:.s .['cu" (::)n.-s:i.t~.:.) se:,~;.u"s and w(.~:.)J.].s as s(~.:.)'L f'cu,'l:.h by the l"]un:Lc:i, paZity c,{ Ar'ic:l"~cu-age (ME)A) and the S'l:.a'Le (::~f AZI. a.~fi.::a. :.'.~.. ]: ~.~:~.:!.:! adhere t.o ail MOA .and Sta'f..(e o~' Alaska rE;)qu:i.r'(:e~mer'rLs ~:'or' 'Lh(.:+~ ~;(.::~'E. back c!:i.s'Lar'~(:::{.:.~,s~ ~'r'c:h'n any E~x:i. st.:i, ng ~uaz,].]., ~,.~as'L(:z~.,,~a'Ler d:i.?,pc:¢sa], system 4. ]: u.~u::h.~-.r'-sT..ar~d !:.hat 1'..his per'.mit J.s wr:~].id f'or a maximum of 0 l:)edr, oc~ms. ,','~l!~ic:) unc:herstarld 't:.ha'L '(:.he Cal;:iac::i. Cy of' 't:.he 'Lc)ia! sys'i:.~,,)m :Ls~i :3 b~::;,cli-oc~ms and any ~:~,F1:!.ar'(;~e¢fi~.:¢lTt'.. ~,,~:i.].]. r'e(::iu:i, re ai"i add:i.-[.ioFla]. ! I f P69M5 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section -- ' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051 171 45 1. GENERAL INFORMATION Expiration Date: Complete legal description PARKS ACRES LOTS 1 & 2 Location (site address) 19437 INLET VIEW Current property owner(s) MORRISON Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex i. ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ED Water Storage ❑ Holding Tank: ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ O/Z 10 _ _. _ __ Date of Payment '�_/ I q ( abao Receipt Number 64523® COSA # J'S G'A0[055� Waiver Fee $ 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 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 2/10/2020 0� A�gSli1 ico q9 6. DSD SIGNATURE • • •� System #1 Approved for 3—bedrooms • �% `'' '� ' J ' CHARLES G BALZARIKI System #2 Approved for bedrooms �� ��c •.• CE -13854 .• .��r Disapproved �li�iF�PROFESS10NPti Conditional approval for bedrooms, with the following stipulations: �r`j WAST! 0"ATER I))))))W) Original Certificate Date: The Municipality of Anchorage Development 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory „ Arsenic Advisory Other Legal Description: PARKS ACRES LOT 1&2 If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1990* Total depth 303 ft Cased to +40 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 2/14/20 Static water level at beginning of test 90 ft. Comments * existing well deepened in 1990 B. TANK DATA Age of tank(s) <1 years Tank type/material steel Measured operating fluid level in septic tank NA ❑ Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA shallow trench (2019) Which system tested (date installed) 2019 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.9 ft (max) Measured depth to pipe invert from grade 7.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective OR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced na gallons Comments/Deficiencies: NEW SYSTEM. COSA Checklist yellow sheet Parcel ID: 051 171 45 Structure served by this system 1 Well production at time of test +5.7 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L 01Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 2/17/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/14/20 Results ❑ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) 0 If yes, enter date 0 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft [] Yes if No ft Neighboring Tank > 100' El Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No ft Water Main > 10' Animal Containment > 50' Q Yes if No ft 0 Yes if No ft M Yes if No ft Water Service Line > 10' 4❑ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Q Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' 4❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Old backup system may not be tested for a COSA until cleanouts and Monitor Tubes are added or extended. G. ENGINEER'S CERTIFICATION I certify that l 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. 3/03/20 COSA Checklist yellow sheet C OF A�,4 �•�co,- 49 TM '• C HARLES G BALZAR1141 ��cis�F�• CE -13854 ��®F�PROFESSI4�P -. rn qu r -5 'o 07 o o-q"c-) 0 squ- 0 m -4 0 cw) M 2: CZ 00 fn x w Z 0 MM X 0 0a 0 m CD -" XW2: © :3 > X w Cl) 14 c cn ON co MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel i.D.~.:~, '~', ~"~ - /~/-,~h (" h(~ ,~o /\ ~) ,,,L"') HAA# ~l~-~- °t[''¥'''~-~''''1~- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot I & 2 Parks Acres Subdivision Location (address or directions) NHN Inlet View Drive Chugiak (b) Property owner H.U.D. ¢031023 Mailing Address (c) Lending Institution Mailing Address 605 West 4th Avenue TeleP.. hone: (home) Anchorage, AK. 99501 Telephone Business · (d) Real Estate Company and Agent ASSOCIATED BROKERS ATT/l: SANDY Address_ 6~,0 West 36th Avenue Suite fll Anchorage. AK 99503 Telephone · 563-3333 (e) Mail the HAA to the following address: (or check here E~xif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Ea_ele Rl~er Loop Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Familyxf~ Number of bedrooms 3 3. WATER SUPPLY Individual Well,g~ Community [] Public [] Note: If community well system, must.have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site)Q[ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'~A AND INFORMATION .. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirEp&: .......... R.NG 17034 Eagle River Loop Road No. 204 Address ~-~ ~;,,~, ~h*.ba 99577 Date Telephone 6. DHHS APPROVAL Approved for ,-:~ bedrooms by Approved .;¢~/~ Disapproved Terms of Conditional Approval ~~.~}//~'~~ t e Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 ;?~¢? ~ MUNICIPALITY OF ANCHORAGE (MOA) .~" '-* [ 'A/~b'"'.~ Hea th Authority Approval (HAA) ' ~ ' ~ CHECKLIST- FEBRUARY 1984 ~ q~ _~ Legal Description: ~o ~/ ~ · -- ~-WEL~'D~ weu A, e, C, Well Log Present (Y/N) ~ . Date completed ~ -~ ~ - ~ Yield TotalDepth ~O~Casedto ~o'~ Depth of Grouting Static Water LeveI ~ ~ ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot / 4242 To Nearest Edge of Absorption Field on Lot ioo + ; On Adjoining Lots / ; On Adjoining Lots [ 0 0 -/- To Nearest Public Sewer Line ~)//,A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~-- ~' B. SEPTIC/HOLDING TANK DATA Date Installed '~-.Z/~-7~Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ! ~O0,~[No, Of Compartments 2 Air-tight Cap~ (Y/N) c1 FoUndation Cleanout (Y/N) /~ Date Last Pumped ~.~- 7~'~{;i~ ,)/F~ ' ;for ~/~ -! Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water,,Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ Lo O ¢//~,,;;~' Date Installed ~ ~ ,2_ ~ - ,¢:~z~-~ ¢ ,/¢J "', Width of Field ~ ~/t Square Feet of Absortion Area Depression ow;r Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field <~ 2~ Depth of Field f I Gravel Bed Thickness '-~ ~--~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot __ '~O 'P To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'-1f ¢~"T'~--'-~ FI~'c~'/~z--¢~ To Property Line [ To Existing or Abandoned System on ; On Adjoining Lots '~O To Cutback (if present) D. LIFT STATION Date Installed % Size in Gallons '~ "Pump On" Level at %'~ High Water Alarm Level at ~ Tested for '~..,~/~ Meets MOA Electrical Codes (Y/N) /~ Comments '~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. S & $--' ~'~' ~IF. NGh*~ERI,-G ...... ~i.,,r I.oo~, Road No. 204 Receipt No. Date of Payment Amount: $ ,./ 72-026 (Rev. 7~88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 · .~. CHEMICAL & GJ ~ Drinking Wati TO BE COMPLETED BY [] PUBLIC WATER SYSTEM I.D.# ~'~PRIVATE WATER SYSTEM }LOGICAL LABORATORIES OF AL,~ ! (907) 562.2343 5633 B Street i .. Anchorage, Alaska Analysis Report for Total Coliform YKA, iINC. teria ~ATER SUPPLIER 1111111 Name Mailing Address City SAMPLE DATE: Phone No. S & S ENGINEERING~, !/u34 Eagle Ri~- Le¢~ Read Ne. 204 Eagle River, Alaska ~5~ State Mo. Day ~ Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code .) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION J 4 I I S l Time Collected Collected ._~ TO BE COMPLETED BY LABORATORY is shoW~~: this Water SAMPLE to be: sfacto~ [] UnsatisfaCtory [] Sample too~ong in transit; sample should not be over~i30 hours old at examination to indicate ~reliable results· Please send new sampl via special delivery mail. Date Receive¢ Time Receive¢ Analytical Me Membrane Filter ,~'No. of colonies/100 mi. Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:. Direct Count ~ Verification: LTB BGB Final Membrane Filter Results Reported By--ate_ ?lme: TNTC = Too Numberous To Count OB = Other Bacteria PART ONE OF ~ Coliform/100 mi CollformHO0 mi 5633 B STREET ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-23z~3 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 26817 Date Report Printed: SEP 4 90 @ 08:21 Client Sample ID:LOTS I & 2 PARK ACRES PWSID :UA Collected AUG 29 90 @ 12:30 Received AUG 30 90 @ 13:10 his. Preserved with :AS REQUIRED Client Name : S & S ENGINEERING Client Acct: SNSENGP P.O.~ NONE RECEIVED Req ¢ Ordered By : R. SHAFER Analysis Completed :AUG 31 90 Send Reports to: Laboratory Superv~orl:STEPNEN C. EDE I)S & S ENGINEERING Released By : ~ ~~ 2) Special Instruct: Chemlab Ref ~: 903348 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.IO) mR/1 EPA 353.2 lO Sample SAMPLE COLLECTED RD3. ROUTINE SAMPLE Remarks: 1 Tests Performed ' See Special Instructions Above UA:Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT~Less Than, GT=Greater Than ~-'~/' 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lots 1/2 Park Acres Subdivision Location (address or directions) (b) Applicant Name Darlene Nicolysen Telephone: Home 688-9192 Business 694-4200 Applicant Address (Owner: Tony Russin, 688-2396) (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mailthe HAAtothefollowingaddress: S & S Engineerin[ TYPE OF RESIDENCE Single-Family ~[]:× Multi-Family [] Number of I~edrooms three (3) Other WATER SUPPLY Individual Well Ek Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the regality and status. SEWAGE DISPOSAL Onsite ~x Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (~1/84) ENGINEERING FIRM PROVIDIN~.~SPECTIONS, TESTS, FILE SEARCH, DA'~AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health · Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of December 26, 1985. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. Approved for three(3)_ bedrooms b te Approved XXXXXXXXXXXX Disapproved Conditional .Tune 11: 1986 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 (11/84) ',.~ 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 GENERAL INFORMATION (a) Legal D~scription (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Applicant Address-- /~ ~'- ~ (c) .Appticant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other,J~ (explain); (d} Lending Institution :~-~/'~¢~ k/~¢~'¢'4/~¢/~.~, Telephone Address ~/.~ (e) Real Estate Company and Agent Address Telephone (f) the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms J Other 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 Onsite [~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 '5. ENGINEERING ¢:IRM PROVIDI~G~NSPECTIONS, TESTS, F LE SEARCH, DA~ AND INFORMATION · As ce:ified 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 o'f 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¢ons in effect on the date of this inspection. Name of Firm __ .~~ .... Telephone ,SRB I96x Address ~ - ~~ Date Approvea ~ ~ v · ved. ~ Conditional ~ " roval~{J ~~ ' ' ~ 2 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-o25 (11/84) RECEIVED /~UNI¢IPALITY OF A~CHoIIILi::;~IClPALITY OF ANCHORAGE (MO~Ay DEPT. OF HEAL'IH &HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: [-'~:::~ WELL DATA Well C assification Well Log P/esent (Y~ Total De~th O,~&. Static Water Level If A, B, C, D.E.C. Approved (Y/N) Date Completed /&,~¢'~)4;~ [~tT~_ Yield Cased to '~:~1'4 Depth of Grouting ~ V~-'c~l Pump Set At ~f~-, Casing Height Above Ground Electrical Wiring in Conduit 4~/N) Separation Distances from Well: To Septic/Ho!d!~g Tank on Lot Sanitary Seal on Casing~N) Depression Around Wellhead ; On Adjoining Lots To Nearest Edge of Absorption ; Field or~ Lot [ c'L31 ~ On Adjoining Lots To Nearest Public Sewer Line ,~ ~'~ J,& To Nearest Public Sewer Cleanout/Manhole ,,' To Nearest Sewer Service Line on Lot ¢'%* J ''~ Water Sample Collected by ~ ~ ~-~ ~'~"~/-~ [,4~,~,3 ¢'1 ; Date J Water Sample Test Results ~/"~"~ Comments /2 k~J~ ',,/!&~_.4::::~ -'~ ,%~--~¢~ ~ ¢~-~' B. SEPTIC/~TANK DATA Size ~ ~',~4~c:~ No. of Compartments Foundation Cleanout~) //~ate Last Pumped ~ ; for Temporary Holding Tank Permit (Y/N) Date InstaLled Standpipes ~N) Air-tight Caps~TN) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l~ Tank: To Water-Supply Well ~ ~'"~*~ 1'4' To Property Line To Water Main/Service Line Course I To Building Foundation L ~ To Disposal Field [ 'L-~1 To Stream, Pond, Lake. or Major Drainage Comments Page 1 of 2 72-02611U84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ ~¢:, -- ~' Width of Field "~1.¢~ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _ ~ ~_~::~ To Building Foundation Lot ~ ~ I Jr" To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course I~F'~?.,-~ Type of System Design Length of Field '~'~. Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Property Line t. ~ t.~ To Existing or Abandoned System on ; On Adjoining Lots '"~q:>~ T~) Cutbank (if present)/ To Driveway, Parking Area, or Vehicle Storage Area ~ (".'.) ~"~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at ~/ l/~ High Water Alarm Level at __ Tested for ~ Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection. Signed .~ A S~B Company Receipt No. Date of Payment Amount: $ Date /2 ~'~-c-2 ~ ~ .5~ MOA No. ~,~'~ :~ Page 2 of 2 72-026 (~ 1/84) ;' '~. ~' ~,~¥~ RECEIVED ~, INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE NSPECTOR I NS.ECTOR ,NSPECTO ) I MUN]CJPALI~ OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~VJRONMENTAL P~OTECTiON 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ~P~ ~ 4 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF I~DIVIDUAL WATER AND SEWER DIRECTIONS: Complete all parts oa page 1. I~omplet~ mqu~sts will ~ot b~ processed. Please allow ten (10) days for processing. I. PROP~Y OWNER . j PHONE MAI UING ADDRESS-- PROPERTY RESIDENT {If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ PHONE . I MAI LING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four L~ a~m~LE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* *ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** \&3[-'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) I /' (HIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE E3 THREE E3 FIVE [] OTHER [] MULTIPLE FAMILY E] 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 [] INDIVIDUAL/ON -SITE DATE INSTALLED E~PUBLIC UTILITY ~-~--- 2 ~' Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: l(~(~)O If Tank is hornernade SOILS RATING give dimensions: TYPE OF TANK TOTAL ABSORPTION AR EA MATERIAL ,~.,.~~ 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS t'APPROVED FOR BEDROOy [] CONDITIONAL APPROVAL (letter mu~ j~f:con2~.~n¥ certificate) 72-010 (Rev. 6/79) ' . MUNICIPALITY OF ANCH~)RAGE MUNICIPALITY OF ANCHORAGE DEPT OF J!~ALTH z DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT (~l~lU~O,.~,~,m~T.,..' g2G L ~tr~et - Anchora0e. Alaska 99 ENVIRONMENTAL ENGINEERING DIVISION JAN ~ 8 Telephone 264-4720 ...... .o. o. ~IRECTIONS: Complete aH parts on page t. Incomplete requests will not be processed. Please allow ten (10} davs for processing. PHONE 1. PROPERTY OWNER ~A[LING ADDRES~ - PHONE PROPERTY'RESI'DENT (if different from above) PHONE 2, BUYER ~AILING ADDRESS J PHONE 3, LENDING INSTITUTION MAI~NG ADDRESS 4. ~A~TOWA~T ~' ~ J ~A~UNg A~O~ESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four  ,.~-Two [] Five Three [] Six [] Other 7. WATER SUPPLY [~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled 'since June 1975. For wells ~ to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [~] PUBLIC UTILITY **If individual/on-site, give installation date /~ ~ f)t~. · if system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '2-010(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 2. WATER SUPPLY PERMIT NUMBER [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLle UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size:.ll~("~(~) If Tank is homemade SOiLS RATiNG give dimensions: TYPE OFTANK MANUFACTURER ~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank ~Absorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5. COMMENTS ~'CONDITIONAL APPROVAL (Petter must ~mpany certificate) ~ DISAPPROVED BY (Title) . LEGAL DESCRIPTION ~ Hr, Arthur Dratlo 515 ~r fi~ ld if said a.~rec~nont ]~ts with your apgroval, '~'te purpose of those egse?n~su~s ~,~_~[,. .... ~ts 'go install o~ thc ~¢outhw~gt con~r of tJ~t i, Park Acres ~ --,, ~ cost of notar- ,law . . . .,., A&~ini~trativt: Director ~Janitarim~