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HomeMy WebLinkAboutPATNODE BLK 1 LT 7 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: OSP251377 Work Type: Septic Upgrade Tax Code Number: 05067101000 Site Legal Address: PATNODE BLK 1 LT 7 G:0254 Site Mailing Address: 19143 JAMIE DR, Eagle River Owner: FORGE ENGINEERING Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 10/20/2025 10/20/2026 43820 Non -Public Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Water 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. Coodinate with On -Site staff regarding preferred method. 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. Confirm location of well on PATNODE BLK 1 LT 6 prior to installing septic system. Issued To: FORG ENGINEERING Issued By: IL - Date: 10/20/2025 Date: 10/20/2025 4 MUNICIPALITY 0 Development Services Department *n-Site Water & Wastewater Section Parcel I.D. 050-671-01 431v zfflm�i� ON -SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Property owner(s) Shannon Morgan & Paul Mclarnon Day phone 907-717-4255 Mailing address 19143 Jaime Dr, Eagle River, AK 99577 Site address Same Legal description Patnode, Block 1 Lot 7 Number of Bedrooms 4 Engineering Firm Forge Engineering Building Permit Number Not Applicable 0 APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Disposal Field E Initial ❑ Septic Tank El Upgrade F I Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: j- Waiver Fees: Date of Payment: 16 ) 1:5 Date of Payment: Permit No. 0 ',--) PaS-1 �371 Waiver No. May 2025 October 13, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Patnode, Block 1 Lot 7 – 19143 Jaime Dr Septic system design Dear On-Site Services Engineer: The owner of the above lot owns 4-bedroom home on the property. The septic system on the lot has reached the end of its useful life, so we are submitting this permit application for the construction of a new and septic tank and drainfield. The attached site plan identifies the location of the home as well as the proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot has a slope of around 10-15%. While there are sections with >25% slope there are no slopes greater than 25% within 50 feet downslope of either the proposed drainfield. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251377, Curtis Townsend, 10/20/25 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=40' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PATNODE, BLOCK 1 LOT 7 FEET 0 40 80 SEPTIC PLAN 10/13/25 10' UTILITY EASEMENT UPPER MCCRARY RD JA I M E D R 4-BDRM HOME GREEN HOUSE GAZEBO AWNING AREA WOOD SHED SHED EXISTING WELLS w/ 100' RADIUS EXISTING TANK TO BE DECOMISSIONED ESTIMATED LOCATION OF MT AND SEEPAGE PIT 1150 1145 1140 11351130 1125 1500-GAL ADVANTEX FAP TANK 20' LONG X 5' WIDE, 0.5' EFFECTIVE DEPTH TRENCH 2CO MTTH#1 CO CO MT LOCATE AND CONFIRM WELL >100' FROM PROPOSED LOT 7 SYSTEM VACANT WELL >100'MOUNTAIN MANOR B3 L5B WELL >100' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251377, Curtis Townsend, 10/20/25 PATNODE, BLOCK 1 LOT 7 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 1.25 MIN/IN APPLICATION RATE: 6.0 GPD/SF 5.0' WIDE TRENCH SYSTEM 1500-GAL ADVANTEX FAP SEPTIC TANK BOTTOM OF TRENCH: 4.0' BELOW GRADE MAX FLOW LINE ELEVATION: 3.5' BELOW GRADE 600 GPD / 6.0 GPD/SF / 5' WIDE * 1.0 RED FACTOR [0.5 DEEP] = 20.0 LF TRENCH REQUIRED (20.0 LF SPECIFIED) 10/13/25 6" 6" 3' 6" Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251377, Curtis Townsend, 10/20/25 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING DEPTH TO WATER AFTER MONITORING 1.25 10/3/25 1 2 3 4 5 6SM (SILTY SAND) Professional Engineers Stamp: PATNODE, BLOCK 1 LOT 7 10/3/25 050-671-01 SHANNON MORGAN & PAUL MCLARNON 2 8 16 OB 3:00 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER PERC TEST LOCATION TECHNICIAN: JUSTIN EARLS 8 8 16 6.0' 10/12/25 COMMENTS: SITE PLAN 6 0 16 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED EXCEPT WHERE NOTED. 10/13/25 MOISTURE NOTED AT TIME OF DIGGING?YES 2 8 16 8 8 16 6 0 16 2 8 16 8 8 16 6 0 16 2 8 16 8 8 16 6 0 16 2 8 16 8 8 16 6 0 16 2 8 16 8 8 16 6 0 16 6:00 7:15 7:30 7:30 7:30 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251377, Curtis Townsend, 10/20/25 0 m RI Z 1(Z,60 I mom. c I oacift Fo 3.1 01� > (n I 0 m 0 �O` { S J gZ 0 -■mac X — /I xri r�\ O • !�•■• C X f x� k c0 @ 0 00 '" © © ® f> G f ■ w : o ao r I s� r: s I 7/ V) n�t u� S• < m r D m ��nn D -{ m m m c m D r O O m 9 �S j❑ m nom m z0 �o rr,Z �I m y c� n� z v z • D J � , W �° co D D m m z Z z D� Z 0 ' 30� • / •. 41 6 %A� U);0 m 0 _ c •1�•1.. 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I , A , L D • s Iy . •. �- PAVED • .•� .,e �. � r Tom) A T f"N I T 1` MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and e tered into as of this Day of 00�r-s- of 202C, bby and between (� ,� , ,:� . herein the "OWNER," and the Municipality of �io,}C Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex system located at (legal description) Patnode, Block 1 Lot 7 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) V,XThroughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. t/ Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) (print name) $h0.�non l�.orgQr, STATE OF ALASKA \✓ ) ss. THIRD JUDICIAL DISTRICT ) Date: / 1 /C 2 The foregoing instrument was acknowledged before me this �� ih day of ncieo A.0- , OT Y PUBLI R ALASKA My Commission expires: .<) z o(r o MUNICIPALITY: By: (signature) tom-- S fzV0 (print name) (rev. 05/18/2018) BRENT D. DUPUIS Notary Public State of Alaska My Commission Expires Jan ,, 2029 ,p Date: Title: C m ( Page 3 of 3 QGRE/ ~.R ANCHORAGE AREA BOI~' JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: D,ST^NCE //~' FROM WELL INSIDE LENGTH MANUFACTURER ~%'~:'/~7~ / MATERIAL INSIDE WIDTH LIQUID DEPTH l]L//-s- o. COMPARTMENTS LIQUID CAPACITY 4 '~C'~:L"?' GALLONS. SEEPAGE Pit: / LINING MATERIAL SIZE: DIAMETER__ BUILDING FOUNDATION .~ '/ , NEAREST LOT LINE__'~2' ~' ADDITIONAL ABSORPTION LENGTHS(';? DEPTH DEPT,__ D,STANCE FROM: WELL 14~ ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE ,/~ ~"2/>/;~ ~) CONSTRUCTION BUILDING '"'~.,_ ,,~ ~' NEAREST FOUNDATION ,' ~f--'~ LOT LINE ~.s~.oo. ~/~ .OTH.. ~o..~.~ APPROVED DISAPPROVED SEWER LINE DEPTH __~,~ ~ DISTANCE FROM: SEPTIC ~' , ;"'" "" SEEPAGE /~ ,m ,TANK ///~'2~ , SYSTEM REMARKS DISTANCES: INSTALLED BY: LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM ~1 . ~ G.A.A.B. Grea 'r ANCHOrage Area Bol~ DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ! Jgh PERMIT O. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT NAME OF APPLICANT ~-/~/~// ~,.~/~./~1.? ,NSTALLAT,ON LOCAT,ON INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT ~ DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ / FOUNDATION TO SEEPAGE Pit ~ , DRAIN FIELD SEPTIC Tank TO SEEPAGE Pit WALL SEPTIC Tank ~'J SEEPAGE PIt ~-~ ~) / , DRain field TO neAREST LOT Line. WELL tO SEPtiC tank Drain FIELD ., SEEPAGE PIt //~"')'~) / ALSO CONSIDER AREA WELLS. SEEPAGE PIT ,/ ~) DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD (~/ ~' SEPTIC TANK, ? ~.J~ SEEPAGE PIT TO RIVER, LAKe, STREAM. CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. DIAGRAM OF SYSTEM 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT GRAVEL laACKi~iLI~ /CZ CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G .A .A .B. OR ENS D DESI R ~'/ I CERTIFY THAT I AM FAM L Q AND LICANT'S SIGNATURE , DAT - FORM NO. E~-01 6 GREATER ANCtlOId\(iL AREA BOROUh.. Department of EnvironmenLal Quality 3330 "C" Street Anchorage, Alaska 99503 S()II~S I,()(; I~I~ROI,ATION TEST P rmed forII?~,~ ;)ate PerfonH,,d Legal Desc ri pt ion: .-.~-Or-.*--- -e~.~ :?-~~~--,--.~:-a lhis form reports: Sol~s log_ ~~_ verco~a:~on s, Dep th Feet 1 -_ 2- 3- 4- 5- 6- 7- 8- 9- 10~ ll - 12.-- 13- 14- Was round water encountered? ~ If yes, at wilat depth? Percolation rate minute. ,Proposed installation: oeepage Pit Drain Field Depth of Inlet DeptT~'-b6'E't~-m'-6:C'pit or trench EQ-040 (6/74) I. -i DRILLING :COM GALS. PER HR'. 3 ©0 g~~ .................................... KIND .OF CASING ....... ~.:...~'. ............ DRILLER'S NAME ...L~./...~.~.'.L.~.[~.-~.....~.f..~..~.~..~.. .................... MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIROf~NTAL HEALTH DEPA~THENT OF. HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, rar~e) Location (address or directions) (b) Applicants Name ~,-~,'11,~ ~L~m~,', Telephone - Home Applicants Address ~o~949 (C) Applican~ is (check~) Lendin~ ~us~i~u~ion ~; ~er/b~lder ~; Buyer ~ ; OCherI I(~plain); (d) Lendin~ Ins=itu=ion Te,~ephone A~ss Business (e) Real Estate Co. & Agent Address (f) Telephone , Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 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 Dispos,al . Onsite ~ Public ~--~ Community ~--~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation a~testing to the legality and status. [Page 1 of 2] E.n~ineerin~ Firm Providing Inspecttons~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation dace shown below, I verify that my investigation of' this Health Authority Approval shows Chat the on-site water supply and/or wssCewater 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 AnchoraEe files and from my investigation and inspection, the on-site water supply and/or wastewaCer disposal system is in compliance with all Municipal and State codes, ordinances, and re§ula- tions in effect on the date of this inspection. Name of Firm Address Date (ENGINEER SEAL) DHEP Approval Approved for ~t/Za%/%z) bedrooms APproved~ ~/~/~,~ ,, ,.,' Disapproved Terms of Conditional Approval Conditional CA~TION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONHENTAL PROTECTION (DHEP) ISSUES m~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN I/~ 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) KK4/eJ/D 18 [Pa§e 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) A~UN~C~P^U~ O~R~UMORiTY APPROVAL (HAA) D~PT. OF ENVIRONMENTAL PR~i~-~ - FEBRUARY 1984 S~P P, 4 ~ Legal Description If A, B, c~ C, D.E.C. Approved(Y/N) Yield Depth of G~outing Well Classification Well Log P=esent (Y/N) ~ ~/ Date C~leted Static Water Level Pump Set At Casing Height Above Ground Elect=ical Wiring in Conduit (Y/N) Sepa=ation Distances f=cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Se~r Line N sanitary Seal on Casing (Y/N)~ Depression A~ound Wellhead (y/N)~ ; On Adjoining Lots }(i~/+ ; On Adjoining Lots To Nearest Public Se~r Cleanout/Manhole /~ To Nearest se~r Service Line on Lot Wate= Sample Collected By Qn~&~- ~ ~ ; Date Ware= Sample Test Results Cc~snts B~. SEPTIC/HOLDING TANK ~ATA Date Installed 5~.4 %~79 Size I~00 No. of Ccmpa=tments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N.) N Date Last Pumped ~ Pumping/Maintenance Contnsact on File (Y/N) N~,; for Holding Tank High-Water Alarm (Y/N)~ Temporaz-~ Holding Tank Permit (Y/N)~ Separation Distances f=cm Septic/Holding Tank: To Wate=-Supply Well . II $'~ To Building Foundation 4i~ To Property Line ~+ To Disposal Field ~' ~'~ To Water Main/Se=vice Line ~4~ To Stream, Pond, Lake, or Major D~ainage Com~lents .m~, Receipt # Date Paid: Amount: ~ [~Page 1 of 2] 2-15-84 5 5 O0 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received March 23, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Alaska Mutual Savings Ban Post Office Box 1120 PhOne: 274-3561 William D. Hansen Phone: 694-9493 Box 949, Eagle River, 99577 3. Legal Description: Lot 7 Block 1 Patnode Subdivision 4. Location: See attached map 5. Type of facility to be inspected 6. Well Data: Individual A. Type Single Family B. Depth No. of bedrooms 4 ,_~:" ~ / ' ,' .-' -(., 301' C. Construction D. Bacterial Analysis Sewage Disposal System: On-site system. .. A. Installed 9-30-?5 B. Installer C. Septic Tank: D. Seepage Pit: E. Disposal Field: l. Size ,'"~ '~;~ l. Absorption Area 2. Manpfacturer 2. Material Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRQ VA FHA 1. Type of Inspection: 2. Property Owner: ~-~)/z'/ //2 ''(/I Mailing Address: BO)4 3. Name of Buyer: .~,f..21Z/~,,'Z4,~. /...~. Mailing Address: 4. Name of Lending.Institution: Mailing Address: ,4 5. Name of Realtor or Agent: CONV. ~ Day Phone: Phone: ~?~' S~-~/ Mailing Address: Legal Description: ~.,o T Location: ~-"~ ~ Phone: Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: No. Bdrms. '~ Individual Public Utility If Individual, date of installation . Individual (on-site) 72-003(3/76) Page 2 of two pages - Re st for Approval of Individual er & Water Facilities Legal Description Lot 7 Block 1 Patnode Subdivision Comments Approved ;~~~~~ Di s~ved v/ Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) C. ABSORPTION FIELD E~TA Soils Rating in Absorption St=ara Date .Installed Width of Field Square Feet of .Absorption A=ea Depression ove~ Field (Y/N) ~3 Date of Last Adequacy Test ~c~ Separation Distance f~cm A~sorption Field: To Wate~-SupDly Well ~D~ ~ To P=operty Line Z5f~ To Building Foundation 90! To Existing or Abandoned System cn Lot A3~ ; On Adjoining Lots I00'+ To Ware= Main/Se=vice Line /OOr4: To Cutbank(if ~esent) ~ To St=earn/Pond/Lake/or Major Drainage Course ~4 ~ To Driveway, Parking Area, or Vehicle Storage A=ea ~f I5o~£/Iw~.,,a:~4~ Type of System Design Length of Field ~o~ Depth of Field ~' ~ ,, Gravel Bed Thickness _ 'Tfo .~ ~ Standpipes P=esent (Y/N) De LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo= Electrical Codes(Y/N) . Ccn~ents Dimensions Manhole/Access ,,~.~ o~f"~.,~vel at Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or eonfc~med to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date cc~ar~y ~o~ ~ ' ~..~..~.~. m/dS/~ %: ~-:""%%:g~-, i.~, [Page 2 of 2] 2-15-84