HomeMy WebLinkAboutPENNINGTON PARK BLK 2 LT 7BOnsite File
Pennington
Block 2
Lot 7B
#020-181-66
Formerly Lots 7A and 8
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: OSP221273
Work Type: SepticTank Upgrade
Tax Code Number: 02018166000
Site Legal Address: PENNINGTONPARK BLK 2 LT 7B G:3437
Site Mailing Address: 5741 KALLANDER AVE, Anchorage
Owner: KARCZ COREY M
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date
�t»cnt S
Q
1 f
t�Cl)81'CI11@I1C
Lot Size in Sq Ft:
Total Bedrooms:
7/29/2022
7/29/2023
51632
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Co01 C—yu,, 41,fs v--,',- 7,
Received By:
1
Issued By:
4
5' frlp / -Z-/ qu
Date:
Date: a 9 020 2
��/�UMUFAUTY OF A H CHORA OE
UD
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-181-66
Property owner(s) Karcz, Corey M Day phone 907-748-7770
Mailing address PO Box 191038, Anchorage, AK 99519
Site address 5741 Kallander Ave, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Pennington Park B2 L7B
Legal description (Township, Range & Section)
Lot Size 51,632 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)x❑
(w/wo AD U)
Septic Tank
❑x
Upgrade ❑x
El
(D)
Holding Tank
ElRenewal
ElDuplex
Multiple Dwellings
❑
Privy
❑
(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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: #1_,;4)' 5
Date of Payment: 7 I&S 2,02 2 -
Receipt
Receipt Number: Q'5
Permit No. CSP,;� �2
Permit App_::- : ,'-..:c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
July 15, 2022
UYE
E E R I N G
Wnicipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COIVfPUANC
OSP221273, Rebecca Carroll, 07/2W
PO BOX 240773
ANCHORAGE, AK 99524
522.7773
677.7766 (FAX)
FORGECIVIL.COM
MOA Development Services, On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Pennington Park 132 L713
Septic Tank Replacement
Dear On -Site Services Engineer:
The owner of the above lot intends to build a new 4 -bedroom home on the property. The existing
septic tank will need to be decommissioned, and tank location changed to accommodate the new
house placement. We are submitting this permit application for the installation of a new advanced
treatment septic tank. The attached site plan identifies the location of the new home as well as the
existing well, and septic location. No conflicts exist between this proposed system and any other
well or septic system, whether on this lot or adjacent lots.
Wells on this and adjacent lots are shown. The new tank will be a minimum of 50' from all wells
and surface water, and more than 5' away from the absorption trench. Please refer to the attached
septic plan for the septic design. If this design is followed, there will be no adverse impacts to
adjacent properties.
Sincerely,
Benjamin Schiller, PE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
PERMIT # OSP221273
PID 020-181-66
SUBD Pennington Park
907-343-7904
Fax: 343-7997
TRACT BLOCK 2 LOT 713
CONTACT PERSON Benjamin Schiller, P.E. PHONE (907) 522-7773 FAX 677-7766
PLEASE GIVE A DESCRIPTION OF THE CHANGE
Client has decided to change the plumbing to come out of the back of the house.
Since we have more than 100' separation from all wells, he no longer needs an
advanced treatment system. We are instead proposing a 1500 -gal STEP tank
for the 4 -bedroom home to connect to the existing field, also sized for 4 bedrooms
CUSTOMER SIGNATURE Date:
On -Site Comments Review
Reviewer: Issued Time
(date) (hours)
APPROVED (date)
TOTAL HOURS
HOURLY RATE $145
TOTAL TO BE PAID
DATE PAID
RECEIPT #
PENNINGTON PARK, BLOCK 2 LOT 7B Co I'- -�-
LOT 9 \ /�� 150.' WELL RADIUS
/� i \100' WELL RADIUS �► I
/ f 10`-UTILIT_Y,EASE ENL(89=75)-
10'79E_EMENT- 8a
EXIS-TING WELL�30
I / / 8/ / x,70 10' T&E EASEMENT Lu I/
740 I "\—j" NO SEPTIC LINE PERMITTED J
I - ` WITHIN 25' RADIUS -OF WELL,
i /,
_ NEW 1500 -GAL STEPJANK / w I
MAINTAIN 5' SEPARATION SHOP i }
-FROM DECK SUPPORTS' ► �- -J
► zlC< ,,-4-BDRM HOME \ ' LLI
- % FCO `, __ J ►
\ \ /
0
i
,
DECOMMISSION,) EXISTING
1 EXISTING/STEP TANK ABSORPTION I
PER U.P.0 T`BED TO /
�
REMAIN;IN
SERVICE
/ Los�— I
/
® / / ► / O % WELL
► i �' LOCATEDbY
/I SITE VISIT
LOT,.1 ►
ENGINEERING NOME:
\� NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND
OF ,1 PROPOS
r� ••''•811 ED SEPTIC SYSTEM CO - CLEANOUT
qb
Ar 49 t9 TH••ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0 -DOUBLE CLEANOUT
• • • PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO - FOUNDATION CLEANOUT
• SYSTEMS. FS - FLOW SPLITTER VALVE
7�Benja'i Schiller 0 MH - MANHOLE
ft •.• CE 2592 ���i 0 50 100 MT - MONITORING TUBE
7/15/22 •••'c�,,r FEET
SEPTIC NT
1"=50' TH - TEST HOLE
PLAT NO. 2013-16
PENNINGTON PARK SUBDIVISION
LOT 7B, BLOCK 2
51,611 S.F. _ -
N 83057'27"E 333.62' 10' T. & E. ESMT. — — — — — — — — —
89-75)
10' UTIL. ESM -r -ESM . —
T
10'T.&E. —
— — — 52.0' n
l
I 10', 1
I o I
I DECK - - , X 775'
40.0'
20.0' I
I
I I
1 I
I I
I � I
I � o
r I
DECK II M I
I I
I I
9.76'
.y - J X 775'
-
I
(N�
/ O GP /
/
/
.9i
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,QO
co
0
f N
2
0lO
N 12.0' 39.9'
EXISTING SHOP
t o
N
WELL M
0
52.0'
PROPOSED
A.C. DRIVE
b 12.0' 42.0'
N
SEPTIC SYSTEM
X
00
.i
M
w
X
N 89045'37"E 49.19'
OF q4 �1
i * : 49TH •:
m •: Jeffery A. Gastaldi .• •o• N
s. LS -6091 �2, jr
4/5/2022 : a AV
r0fessional \-a�\
•�1I■1Ls
6-11AU-1
1 11=30'
ELEVATIONS BASED ON 1972 NGS DATUM.
PLOT PLAN
I HEREBY CERTIFY THAT I HAVE SURVEYED
THE PROPERTY DEPICTED ABOVE AND THAT
GASTALDI LAND
THE PROPOSED IMPROVEMENTS AND DRAINAGE
SURVEYING, LLC
PATTERNS ARE AS SHOWN HEREON. IT IS THE
JEFF A. GASTALDI, R.L.S.
2000 E. DOWLING RD., SUITE 8
RESPONSIBILITY OF THE OWNER, PRIOR TO
ANCHORAGE, ALASKA 99507
CONSTRUCTION, TO VERIFY THE PROPOSED
PHONE 248-5454
BUILDING LOCATION ON LOT, BUILDING
GR ID
DATE
DIMENSIONS, GRADE AND UTILITY CONNECTIONS,
SW3437
4/5/2022
AND TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
F. B.
Job No.
WHICH DO NOT APPEAR ON THE RECORDED
PPS7B2C
SUBDIVISION PLAT.
MUNICIPALITY OF ANCHORAGE PLATTING CASE NO. S-11894
APPROVED ON OCTOBER 24, 2011
PENNINGTON PARK SUBDIVISION
PROPOSED LOT 7B, BLOCK Z —SEE NOTE
51,611 S.F.
x� N 83°59'05"E 333.99'
10 UTIL. ESMT. (89-75)
10' T. & E. ESMT. — —
— 'o
\ o Qo
G•o.
G
-f
\
f�
L
t�0 SEPTIC SYSTEM
o i
o.
00
F
tj
O
A�
O�\JE
PG.
Cok
56.0'
10' E-ESMT_ — — — — — — — — —
J O�
O O
� 52.0' I
I
o PROPOSED '
' M GARAGE
I
WELL I I
� I I
I I
� 52.0' '
� I
J
�g0 00
O$
h1 .
o, � PEEN
NOTE: THIS IS A PROPOSED RESUBDIVISION AND
THE FINAL PLAT HAS NOT BEEN RECORDED.
vRe�
GRAVEL DRIVE
\'��d
AS -BU I L
00'00"E 49.52'
41 N112
V
ui
_ 50'
N
0
0
0
w
41
EXHIBIT B
♦'`:•.�
i * 49TH 10
0. m •: Jeffery A. Gastaldi •: •o• �
. s. •. LS -6091
. sP •. 10/5/2012 4w• rOfessiona\
T
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
2000 E. DOWLING RD., SUITE 8
ANCHORAGE, ALASKA 99507
PHONE 248-5454
IGRID 3437 I DATE 10/5/2012
F.B. I JOB N0.
PPS7B2B
I
l�l,�
N 900
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
AAROW PUMP Bl. WE« SERVICE, LLC
P.O. Box 110496
Anchorage, AK 99511
Office: (907) 346-9355 • Fax (907) 333-8976
Eagle River: (907) 622-9335
Peon ��%n pare /j 2 L7
/ JOB SITE
/lam
CUSTOMER /
WOKE
No. 9425
INVOICE DATE
WELL DEPTH
SWL y.
CHLORINATED
PUMP DEPTH
SALESP�/ON /
QUA ITY
DESCRIPTION
PRICE
AMOUNT
ICS C-' e'
15 ,
•% C% � � J iiQ/roti ! ' / � � �'r-/`J
-- - - -
---
/C ✓
LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
TOTAL LABOR
WORK ORDERED BY
DATE COMP.
TOTAL
I
LABOR
PAY THIS AMOUNT
I �� -2�J
%
2
Thank You
(/ — SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion a Ab a Des/cubed Work and agree that if above work is not paid for in 90 days I agree to allow Aarow
Pump & Well Service, L.L.C. the right to rem paid for equipment and charge for labor already performed & labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES Plcdt6~ Tec~nic<:zl Service~
Environmental Health Division ].4530 Echo Street
825 "L" Street, Anchorage, Alaska 99502, Telephone 264_4720.~.Tlc~lor~e, z~](:[$].cc~ 9951[
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
~,~. ~r~ ~m~~ ~ DISTANCES 0~0-/~/-~
Address // ~ I~/ ~f~¢~ ~ SEPTIC ABSORPTION
~u~._~j R~ ~o~ ~ ~f~ TANK FIELD WELL
Phone(s) J~rm,t N~--- {No. o, Bedrooms --
LEGAL DESCRIPTION LOT LINE
Lot / Block ~
Town~h,p, ~9~,S~.o~ FOUNDATION ~' ~ l ~'
~ eC (0/ ~ II N/ ~ ~ ~ AS-BUILT DIAGRAM (Show Iocat,o. of well, septic system, property hnes, loundabon,
driveway, water bodies, etc.)
TANKS ~- :~~
Manufacturer ~ ~ ' ~ ~~ ~ ~ ~
TYPE OF SYSTEM z _ ~ ~~ ~~.
or,renal rade ~ depth froze'-- // i. '~' I ~ -
FdladOedaboveorlglnalgrade ~-:~~~ I/' ' j ~,:,~f ~ ,r .~L-- " ~~ ~ J J
. el depth beneath me [ --I ¢'~ ~ ~/ ~ I~ ~
~Ti~%~- ' ' ~ -~ ¢ Mff _~c¢. ~ ~¢ I I !
.... FT 30' ,or' ........
~ance De[ween lines ~ ~ ~ ~ ~ ~ ' ·
~ PRIVATE ~ ~ ~
, FTI " , , ~ ~c,~a~ ~ ~,: X~3~-- '~
~ r ~ Scale: I~- ~ -- ~ i ,
...............
CUrllly mai I~lS Inspecu0n was eHormed ac ' * ' * '
M P cording l0 all d ~ ~ ' ' '~ ' ' '2~'
unicipal and Slate guidelines in effecl on this date. [0 f ~/ / ~
.... ~ "~ ............
~ Date' /~ ~o/ ~ qq ~ ".,, ,*''
72-013 (3/85) ~:~. ', ~'.. :,...,,:,~ ~;':~ I
:1; I",IF E)i::~I':~ D ,, ["'f ,, H ,, :iii~ ,, F:;'F;.: ;I; E)I;:;,' "t"0 ;I; NSF'I!!!Z:;T :[ EJNS B Y iii!:l',lE') :1: I".IE:EI:;~ .,, :[ F:' AF'T'I!ER
(;)I::;'I::; :[ CE I'"IOL!F;.'.!i~, CAI....L :::.!;4.::~P'"'4.61iit:l. r:.':d',l):) LEAVIE A
CEII',iSTF:;'.LJC'I F;:'E;F;,: ENfZ.Zii]ZNEEF;~'.S AT"I'Af:Z;HtED AF::'F"I;:;:OVEZ)
!"1'-'1 ;[ S I:::'EIRI4 Z[ 'T' E: X F' ;[ l::;,'E~ii~ :1.2/5:1. ,,"EFi;' AND VAL.. ]: D F:'OF;: A S Z[ I",It;t....E F'AH ;[ L.¥' I...IOMEi: ,,
N=~d'70~
1'
SEPTIC
~LA~ ~
$C,~t.O : I"'-$~'0''
PENNIN 6TON PARK
~attb-~ T~chnica! Services
~4530 Echo Street
Anchorage, Alaska 995~n
BKO I 9~378'722
GRANT OF PERPETUAL EASEMENT
The Grantor, as Secretary of Veterans Affairs, an Officer of the United
States of America, whose address is Department of Veterans Affairs,
Washington, D.C. 20420, the owner of Lot 8, Block 2, Pennington Park
Subdivision, Anchorage Recording District, hereby grants a perpetual easement
allowing construction and maintenance of water supply and wastewater disposal
systems and reserves on Lot 8, Block 2, Pennington Park Subdivision. Serving
the residence located on Lot 7A, Block 2, Pennington Park Subdivision,
Anchorage Recording District, together with service lines as needed connecting
these systems to the subject residence.
IN WITNESS WHEREOF, Grantor, on the~~A day of~_~O,~r / ?~
has caused this instrument to be slgned and sealed in his name and on his
behalf by the undersigned Loan Guaranty Officer, being thereunto duly
appointed, qualified, and acting pursuant to sections 212 and 1820 of
Title 38, United States Code, and section 35:4342 of the Regulations
pursuant thereto, and who ls authorized to execute this instrument.
Edward J. Derwinski
Secretary of Veterans,,Affairs ~q
Loan Guaranty Officer ~ ~
DVA Regional Office, Anchorage, Ak
Pursuant to a delegation of authority
contained in DVA Regulation 35.4342
(38 C.F.R. 36.4342)
STATE OF ALASKA )
) SS:
THIRD JUDICIAL DISTRICT )
6~-0S9697
T
he foregoing instrument was acknowledged before me by ~o~r~;~ ~.
~W'~?!.~>Y'~' ~-r' , as a Loan Guaranty Officer on behalf of
Edward O. Derw~nski, Secretary of Veterans Affairs.
.,." .;' ~
,,,.'¥.~, l ,,. /~ %:
My commission expires:
ANOHOR~,~;E REO
DISTRICT ]O~O_~ My Cornmission Exptre';
REQUESTED BYJ~d~ Let. m6 ~'°*~"~
'89 OOT 5 PI~ ~ 50
Lots 7 & 8, Block 2, Pennington Park S/D
5741 Kallander Avenue
Septic System Upgrade
Specifications
1. The septic system upgrade shall be constructed as shown on the plans,
except that minor modifications may be allowed or required by the engineer
conducting the inspections. Since the underlying gravel has a faster perc rate than
that of the sand to be used in the mound construction, the size is based on 125
square feet per bedroom for the sand. (125) x (4) x (1.5) - 750 square feet. ,
2. All construction practices and material specifications shall conform with
M.O.A. requirements.
3. The existing septic tank and seepage pit are to be pumped, and the tank
is to be crushed and buried in the seepage pit as it is backfilled.
4. A new 1500 gallon, two compartment, steel septic tank with an "Orenco"
lift station package as supplied by Anchorage Tank is to be installed outside the
100 foot radius from the well, and a new 4" dia. waste line installed connecting it to
the existing foundation cleanout. The lift station shall utilize a 1/2 hp. sub mersible
pump capable of pumping 33 gpm at 30 feet of head. The on, off and alarm float
settings shall be as specified by the lift station supplier to give a 131 gallon dose.
A visual and audible alarm shall be installed inside the garage.
5. The contractor shall be responsible for obtaining and paying for the
necessary electrical permit and inspection, as well as all utility locates.
6. The pressure main connecting the lift station to the distribution manifold
shall be 1.5" dia., 110 psi. high density polyethylene pipe as supplied by Maskell-
Robbins (or equal). Approximately 200 feet of this pipe will be needed.
7. The soil absorption mound shall be constructed by excavating the surface
soils of the designated area down to the top of the gravel stratum at approximately
1.5 feet below ground surface. 2.5 feet of medium sand shall then be placed in the
excavation and compacted to achieve a level surface I foot higher than the original
ground surface.
8. A total of 9 inches of approved sewer gravel shall then be placed on top
of the sand, with the bottom of the distribution manifold and laterals located 6
inches above the top of the sand. The manifold shall be 2" dia. scheduie 40 PVC,
and the distribution laterals shall be 1.25" dia. schedule 40 PVC with 3/16" dia.
holes drilled in the bottom at 30" spacing as shown. The ends of all the laterals
are to be capped, and all pipe connections in the pressurized distribution system
are to be glued.
9. 4" dia. monitor tubes which include perforated pipe extending through
the depth of the sewer gravel shall be installed at the locations shown on the plans.
Two inches of rigid, burial type insulation shall be placed over the top surface of
the sewer gravel before covering the entire field with 2 feet of unclassified soil.
The sides shall be sloped down at 3:1.
10. Four inspections will be required during construction: ( 1 ) Initial
stakeout, (2) After the excavation is complete, but before placement of sand, (3)
After the sand is placed, but before placement of the sewer gravel, and (4) After
the gravel is placed, the pipes are laid and connected, and the lift station is
installed, but before final backfill.
~ 4.X ,,n~nc~c~n box
PVC LrN-d]N
E4° x 4' $' Cu~ve.r'~ Mo~hote
1' Flexible P~:~ux-e Ho.se
~." P V C P~e Ty'p
Re+,rmv~L rope
~' x ~ dJc co[lo~
pu~oou~ --
3 3/4'R
hole
i
Ftc~p check
C
~[ JHPTNG PRFSS[ JRF
--2' Ur't~h~e Po~ (.~h~p o~opUecL,
myth Tnemac 'top c.~:'~
--A~LJ~_~ t~dole Fl~l't S',l'tch A_~-e~oly
-- Seal ~l;h RAM-NEK or Equ~
--JHool~ l'~td do~n
i 174' welded ~-tee[ c~upUT~
--4'pvc ?Low trmtucer
--t 3/8' h.olee 6' DC
--L/~' r~h polye'bhylene ~
15' ~(l x 39' I~gh
--1/2 h.p, U,I_, Lis-ted S'ul0 gJ,~,r s~te Pump
---- P.e'~mm~z~g o, nole~
Flattop Technical S~rvices
14530 Echo Street
Ar~choraqe, Alaska ~ 99518
SYSTFH P~,A-~.~ ~r ~c~o~,~-~:~ r~"
1250 1500 2000
Reserve C~p~O~y
~d0ove Alcr~ 161 GAL 198 GAL 257 GAL
C_xlp a cJ~-y Between
PuMp on & Pump o~ 109 GAL 131 GAL 175 GAL
Flo~ Level ~ Pt. OAT COR.O AT
~e t Lu'~Qs
A~ove Voub~ AJ, oJ"'-M ~7' 48' 45"
Bu L tom On / O-F'f' 41' 4.~
LIFT STATION DATA
0 B 1,0 1§ 8.O 8.5 30 35
Oo11~rts per M~Oum. e
TYPICAL PUMP PF_EFO NCE CURVE
~-ZE SI~ELL A B C
~0 18 ~ 1~ ~'9~ 48 1~' (4 B~
~00 10 ~U~ ~4' I~ 3~' 64 ~8' ~ & 6
NBTE
SIZE CHART
- LIFT STATION TANK~ MLI~T BE P.6-D GALLONS LARGER THAN
~TANDARD TANl(~ FOR .~kME APPLICATION
NOTE-
Flattop Technical Services
14530 Echo Street
A~choraqe, Alaska 995]g
~&c~r~t 3'-0~ o£ 2" pt~.
Flattop Technical Services
14530 Echo Street
Anchorc~ge, Alaska 9951a
PERPORMED POR:
LEGAL DESCRIPTION:
2
4
8
9
10
11
12
13
14
15
16
17
18
19
2O
-r. t4, n-~,
Flattop Technical Services
14530 Echo Street
Anchorac~e, Alaska 99516
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
'r'~(- 8ore #a
(/'e. /.-e ~'~Cra~
I ~'"--". ........... . ..... ~...~l
! ,,4~ ~THEODOEE. F. ~OORE: J~ I
/ *,% .. c,_-3589 .,' ~,,,
/ ',F~2::.. .......
DATE PERFORMED: 6~/,~S /6:)
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? ~ ~. II pO
E
Depth to Water After .
Monitoring? ~0 Date: c~ 1 7/~
SITE PLAN
Reading Date Gross Net Depth to Net
Time Tim. (-~;4 Water D~o.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND ~FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: '--~"~~O)~ /¢ /9~9
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: L. 7,. 82. PCm~¢~,~
- V
t'l t,, .% It I.,o~
2
4
5
8 Eof/o,,, of I~1~
p~.-~-Township, Range, Section: ..CEC' I~ / '/'liN, R.~ ~ ;
SLOPE SITE PLAN '
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER
ENCOUNTERED? ~'
S
L
IF YES, AT WHAT
DEPTH? ~ ~ ~l 0
P
Depth to Water Alter ~,~.
Monitoring? ~, Date:
Gross Net Depth to Nat
Reading Date Time Time Water Drop
PERCOLATION RATE
__ (minutes/inch) PERG HOLE DIAMETER
TEST RUN BETWEEN
~.r J'~ Ile¢'(. I'~ te
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE,
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: ~)l/ /0 t/~;'~
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
IPHONE I~'OPG RADE
MAI LI~ A b DR~ESS
DESCRIPTION
LEGAL 7 7. __
LOCATION NO. OF BEDROOMS
] Well I Absorption area Dwelling PERMIT NO.
~ DISTANCE TO: ]
I
~ Manufacturer ~1~~ Material ~o. of com0artments
kiq. ca~acit~ in ~allons ~ IF HOMfiMAD~: Inside length ~idth kiquid depth
TO:
~ ~ ~ Manufacturer Material Eiquid caoacitv in ~allons
Foundation t ~earestlotline r~ ~[~MIT~O.
~ ~ ~ .o. of line, Length of each ~ne Total length of lines mr.nch width Distance between
~'~ Top of tile to fin,sh ,r.de ~-- Materi. I bene,tht, I. '~ ~ ,~ Total .ffe~v~0t,on are..
ken,th ~idth Depth Pfi~MIT ~O.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest tot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TLS
INSTALLER
REMARKS
...... i,.,~nI
DATE LEGAL
lev. 3/78)
........ f.E::.t.,.I ON F.:"t".
:'1... !5 M ]' ":i" L..[',EI",I ' .....
I....';::' E',;;:;i: F'I!:'::I'.,lI"4 ;!; I',IGTOI",I F::'I:::II;;.'tK
PII:::t% :!: i"'tI...IM NI...II'"!E:I!!i;I:;;: "'ii:::' I:ii [::'f',F;.' "'
"I'HE L. IENG"f't"I E:' :t: MEN:.:.!; ]; O1",1 ]i; :i!!; "f'HIE I....EI',t(}iTH ':; .'[ I",! F:'EE;T ::' OF::' 'T'I'"I!E "f'F;;:EI",IC:H OF;i: E:,F;;:F:I
"l"l'"lEi: I:::,E;F::'"['H X i:::' FI 'T'F;i:E'~t',tC:H '"d:;? F::':['T' ;l;l;;!; 'T'HE[ E:,~:.:.'i;TFII"tE:IE I~HJ!~."f'HE:E';N 'THE; :i:.';UF;;:F::'I:::!E:F
':il:;;' ;L) 1.11'.4 [) I::II",l [) T HIE ['.:.', O T' [' ")M O F::' "f' HIE E;. ;:':;I.'.:: I::l'v' I:::l"f' ]' ';; i" I ,:; :1; i",t FIE E"I" ).
'T'I."If.':.:;F;~:IE ]; t!!!; 1'-I ;;'~ :!!!;IET H): E:,TH I:::'OFi: TF;'::E;t'.4CHIL'ES;.
"l'-Hlii!] .;~ir;J:':i, El .... E:,EF::'TH ;1: 5; TH!E M .T. I'..I ]; MUM DIEF::"T'H ';;ii:::' EiiF;?l:::l',,,'t~ii:l E',IETH[.-71i:.:;N "f'f-.lt!i!; '" rf'F:'F:ll... F::'
i::I!'.,IIE:, 'T'Hli.'-'.; Ei',OTTOM (" F:' THE!; F::'"' "' I:::1' 'F .... : f. ,' :!; 1'.4 F::'Ii:!;IET
GAAB-HD- I
GRr:ATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCRIPTION~,~-7~ ~ ~"',~)~'.L2~. :~.,¢//)s/~=77.)/./~;
SEPTIC TANK:
DISTANCE FROM WELL .~--
LIQUID CAPACITY
GALLONS.
NUMBER OF /
MATERIAl ...~'~ .7'-~L--~.,~---,~-. .COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH ~- DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MA~I'ERIAL "~ ~ -- ~
-- OR WIDTH
LENGTH
DISTANCE FROM WELL /~'~ ~" /
, BUILDING FOUNDATIO
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,-~"~,~
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL .~ , FOUNDATION.
ABSQJ~ION AREA ",,..--.-"'"SQ. FT. LENGTH OF EACH LINE.
, NEAREST LOT LINE.
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
"~'"~ ~"/~¢'~"'¢ ' '~'-'-"¢') DISTANCE FROM ,, . WATER
WELL: TYPE ,¢~--"~"/','~--,/-~-~-*"~ DEPTH " , BUILDING FOUNDATION.
NEAREST ~ SEPTIC (~'~m ''-) . SAMPLE
~ SEEPAGE
LOT LINE SEWER LINE , TANK - - , SYSTEM ..... , CESSPOOL
DIAGRAM OF SYSTEM
, NEAREST
OTHER
, SOURCES
DISTANCES:
~-- ~ c. --/O V:~ '
GREATEk ..NCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
ROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
LOCATION OF INSTALLATION
.Z ,o.T ,/ ,./" f
SEEPAGE PIT , DRAIN FIELD , OTHER
PERCOLATION TEST RESULTS
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
TO BE INSTALLED BY /~"~-"'~~'/
ANTICIPATED DATE OF COMPLETION J U~-v JO ~"' ,
THIS IS TO SERVE AS /'0~/ D/~rL'?' A/~/qtO , PERMIT TO INSTALL A
<~'~"E/~/~ftM~- //~"~ AS DESCRIBEB BELOW. SIZE OF UNIT TO BE SERVEB
· SEPTIC TANK SIZE
Health Authority
(
TYPE ' '(-.]O~J, , SEEPAGE AREA is TYPE ~L~' ._
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE
GAAB-HD-I
Gl' ,TER ANCHORAGE AREA BOROI 1-1
DI=¢ARTMENT OF ENVIRONMENTAL QUALI'[f
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
D,STANCE FROM WELL
LIQUID CAPACITY_
GALLONS.
ADDRESS ~ PHONE
~'"JY---~; / ~ NUMBER OF
C~ OMPARTMENTS .~ /
MATERIAL
.~""~,,/~O~ ,~'7"'~?-~'"~Z' '~ "/",'~/'~"'~""~;:J:~')~"~'J- LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS .OUTSIDE DIAMETER
NEAREST LOT LINE ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)_
OR WIDTH__ //~//' LENGTH
,
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL/ ___, FOUNDAI'I~,~ NEAREST LOT LINE
NUMBER OF LI DISTANCE BETWEEN LINES ~.~[RENCH WIDTH
ABSORPTION AREA .... SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES j ,
,.,,,,,T,~ A L EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAl_ BENEATH TILE
IN. ABOVE TILE,~
WELL: TYPE /~'~,~-,"~//~'~:/~ DEPTH ~' DISTANCE FROM
BUILDING FOUNDATION.
~ NEAREST SEPTIC ~ ' SEEPAGE
LOT LINE ~ SEWER LINE ~ , TANK SYSTEM.._.~C~
WATER
SAMPLE
, CESSPOOL
NEAREST
OTHER
SOURCES~
DISTANCES:
l~ b T~.- ,
t4.'~zx
DIAGRAM OF ?~YSTEM
JF
DATE
Grimacer ANCHORAGE ARea BORoUgH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT
PERMIT NO.
NAME OF APPliCANT
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SiZe OF FACILITY TO BE SERVED
FinanCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
DRAIN FIELD
OTHER
NOTE: THIS PERMIT is NOT VALID WITHOUT SOIL
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 i TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit
SEPTIC TANK TO seePAGE PIT WALl
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 ~c~:
ALSO CONSIDER AREA WELLS.
SeePaGE Pit / c~;
DRAIN FIELD.
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 TO BOROUGh REGULATIONS REGARDing INSTALLATION.
HEALTH AUTH ORIT/Y/~-
0 R
LICENSED D ES l ~[~;q E R
I CERTIFY THAT i AM FAMILIAR WiTH THe REQUIREMENTS OF GREATER ANCHORAGE Area BOROUGH ~/RDINANCE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. . ~ '~ -~
NO. 28-88 AND THAT The ABOVE
GRE~FER ANCHURAGE AREA BOROUGH
DEPAI iENT OF ENVIRO~ME~TAL QUA!..
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
CASE #
Performed For Floyd Palmateer Date Performed~ 9/2/7
Legal Description: Lot__~Block. l~ubdivision Pennington Park
This Form Reports Soils Log x ~ation T~st
Depth
Feet
Soil Characteristics
Dark brown silty sand (SM)
Gray and brown sandy gravel (GW)
with~silty sandy gravel seams (GM)
WAs Ground Water Encountered?
If Yes, At What Depth?
no
Reading Date i Gross T'
Net. Time
Percolation R'~te Minute
Proposed Insta~'la'~ion: Seepage Pit ×
Depth Of Inlet
COMMENTS:
Depth to H20
Net Dro
Drain Field
Depth To Bottom Of Pit O~ Trench
IR~ ~,~. ~r__ o~ drainage area is rcquircd pcr
Test 'PerfOrmed By ~. ~. Carlisle Da~a CeF'{ifi'ed -B-y:N~ Testing Svs. Inc.
Da t e:
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
(c) Lending Institution
Location (address or directions)
5-7
(b) Property owner (,,(,.C. ~/~L~r~_¢ /~'~ Telephone' (home) Business'
Mailing Address c(/~ ,j,"'~c.,f,y /,¢~/~, /~_¢f(~,.~ ~('/7'/ /,~.(~{-~o._,~ /Zlr, nC/~c,,'-',¢r.~'¢
/~, ,4, Telephone
3
Mailing Address
(d) Real Estate Company and Agent
Address ~' ~, z.(/ /Z~r(cx/L/~
Telephone 2~ ~,5- - ~00
(e) Mail the HAA to the following address: (or check here i~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms /7/
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 th legality and status.
4. SEWAGE DISPOSAL
On-site [] 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
ENGINEERING FIRM PROVIDING 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 investigatior~ 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.
NameofFirm f='~/cx )L/~f) 7"-¢c,/~ a ''¢c~f .-~"¢J' Telephone
Address / ~5-~ ~ ~C ~ ~.~ ~c~o ~,
Date ~o~ ~ /~
Engineer's Seal
6. DHHS APPROVAL
Approved for~-~(/M/) bedrooms by
Approved AV' Disapproved
Terms of Cc~nditional Approval
Conditional
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 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 DHHS 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.
72-025 {Rev. 7/88) Back Page 2 of 2
A. WELL D~C~
Well Classification
Well Log Present (Y/N) N Date Completed
Total Depth 8¢ Cased to 8~' Depth of Grouting
Static Water Level ~' o,~ ~¢/~'/~
Casing Height Above Ground ~ t'
Electrical Wiring in Conduit (Y/N) Y
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by '7-F'/~/
Water Sample Test Results .~'¢xf-cr .?-¢~¢/~r,y -
If A, B, C, D.E.C. Approved (Y/N) N.4,
Yield E',5-,.,¢,/¢,¢ /~,~.xE/B,/~
Pump Set At ~' ¥ /
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
(V
; On Adjoining Lots
tO! ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed to/~1/8~ Size
Standpipes (Y/N) Y'
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Air-tight Caps (Y/N)
No. of Compartments
Y' Foundation Cleanout (Y/N) ¥
Date Last Pumped N.~,
~N, A~, ; for ~' ~'.
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line ,5-'O
To Water Main/Service Line ~> ~-~-~
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
!
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed IO/'.~ t {
Width of Field :~O '
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
//~(r,,-~ Type of System Design
Length of Field 3~'
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation I
Lot ~ f~-o ~
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line I0 '
; On Adjoining Lots
To Existing or Abandoned System on
To Cutback (if present) iN,~.
Comments
D. LIFT STATION
Date Installed IO (.~l/8¢
Size in Gallons 15-'00 ~,,~! .c ,4.
"Pump On" Level at CorC~- ~ ¥/"
High Water Alarm Level at C~,~'~,~ _(~
Tested for N,A, ~11¢cu)
Meets MOA Electrical Codes (Y/N) IE(ec
Comments .5',,~ ¢1¢' ,,~(o, ct ¢ ~%t r,,t.r
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.o,7~_/ ~ ,~,;' OF AL L~,
Signed j.~'~-~c~r_ ~. ,~ _~,'~% ........ .?,~-,
A
Company--~~~f ~cba;~ ~ ~¢3'~.' ~ '.~ ~
~ ~ ~ 4~ ~ ~ ~ Engineer's Seal
Date ~(o~ 8/ /¢~ ¢ .......................... a
MO~ ~o ........ 'a . m[o~o~[ [. }~o¢~a .. ~
~.;~., . CE-3589 .- 0~_
Receipt No ~{ b~ ~ ~P~ess~x*X ~
. ,/ ~ ~ . Receipt No. ~%--~
Date of Payment ~¢ ~/ Waiver Fee: $
Amount: $ / ~ o ~ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
"z,'.'~ ~ P
VICINITY ~AP SCALE I IN. = I MILE
LOT 7A BLOCK 2_
PENNIN6TON PARK SUBDIVISION
COOPER AND COMPANY
e
//Department of Environmental Quality
'~" Street, Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Date Received .~./~./~:>~
Time of Inspection
Date of Inspection ~////YTK-
~/
1. Approval requested
Mailing Address:
2. Property Owner:
Ma i ling Address:
Legal Description:
e
Be
Phone:
Location:
Phone:
Type of facility to be inspected
Well Data:
A. Type _Z~---~/-~Y--z/ B. Depth
No. of bedrooms
/
C. Construction
D. Bacterial Analysis
Sewage Disposal System:
A. Installed /,~ B. Installer
C Septic Tank: 1 Size ./~g~'~6'~ 2. Manufacturer
. . ,
D. Seepage Pit: 1. Absorption Area ,~7/~mo 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
, Absorption area j~/h , Sewer Lines
, 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
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of Inspection:
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Name of Lending Institution:
1 . CMRO VA FHA
-~,./~,~rF' p~/ ~/7~ /~ Day Phone
~-~' C~~ Da~ Phone
5. Name of Realtor or Agent: .~-f'~}.~ ~0 m~
Mailing Address: ~'~,~ ~ /~y~ Phone ~'~
Legal Description:
Location:
Type of Facility to be inspected:
Water Supply
Type of Supply:
Public Utility
Individual
If Individual, number of dwellings presently served
I
If Individual, depth of well /~¢~/
Sewage Disposal System
Type of System:
Public Utility
If Individual, date of installation
Individual (on-site)
EQ-037 (1/74)
Page 2 of two pages - Red.est for Approval of Individual ~:wer & Water Facilities
Legal Description
Comments
Disapproved
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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)
