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5UUMITTA[
JUL 2 5 2013
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page ( of Z
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: 4(.v)040 t07 PID Number: (9(5-721 —1 5—
Dwelling:
Dwelling: Single Family (SF) ❑ Duplex (D) ❑ Mult'ple (SF and/or D) Project: ❑ New Upgrade
Name:
S avn f r
ABSORPTION FIELD
❑ Deep Trench •
❑ Other
Shallow Trench ❑ Bed ound
Address
Phone
Number of Bedrooms
3
Soil Rating
GPD/SF
Total depth f . original grade
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
�(3
/-1t ✓ //t 'Lace' h (I S as
Fill added above original gra. -
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
FL
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total a • orption area
Ftp
Number of trenches
Dist. between trenches
Ft.
Well
Ivo t
c�OrtL
TANK ■ Septic S.T. E. P. ■Holding IE Other
Manufactur
r fJ
'LK •
Capacity
(� 0 Gal.
Surface Water
No
NA
Material //
S +' C4•
Number of compartments
Lot Line
ZJ '4
Foundation
/�`
LIFT STATION
Manufacturer
Capacity ///�
Gal.
Curtain Drain
/
Lv f..
Remarks i „t 00 t �,�,t I
lei {ow
Pump on level at
n.
Pump off level
in.
High water alarm at
in.
l 11 /
m `� {-on YL Pwv. h 2� '�'
t �, �,�
Pump ma d model
Electrical Inspections performed by
Installer / { �% r
N-1, / tic( As ctcr4un P. r
PIPE MATERIAL House to tank Tank to
30 3 K drainfield � .541'
Drainfeld CO/MT
Inspector rat c
I YI d C r 40 ytr E,
BENCH MARK (Assumed elevation)
Inspection fu s �!/ 0� 2nd S Ea 0'l
dates:
Location and description
3" 4th
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date or
..,,zar"p
r—tOFq
C ......•,��
r •lp'•*• 'r��+
. t.. $
`A � ;* 1,
►c 0
�0 MICHAEL N. ANDERSON : r
�. CE -94 :y�o
_�••.ir7 �d�ow
�`1�``` `� r,
%*.•49TH
Approved p(/j
1•
% j
/� Date/a�//3
nspection rteport_5-i -1 zooc
.Permit No SW040107
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: HERITAGE HILLS BLK 3, LOT 3
PID No . 015-221-15
__ /
( /
SEPTIC N /7
N.
N. \ /
---..— / / 100 WELL RADIUS
/ /
/ iN,
S
UPC
/
I /
SEPTIC/
-y1 1NEW 100' GALLON STEEL TANK
1 1
10A / BENCH, Du`
1
CRIB �
\I
--_J 1 0 3
CO S-5
-LL
1
1111 1L-
tta1
\
CO _
\
SHED \
_
HOUSE
\ B
EXISTING TANK DECOMMISSIONED FER
MARK
A
E
\
C01
TC01
TCO2
CO2
CO3
22
22
21
22
23
24
27
32
35
36
\
\
\
N ASBUILT
N.
-, SCALE: 1"=30'
. CO
Tcm
TC
coz
coa
♦♦ f Cf. ••
•
•IE
Ii •: MICHAEL N. ANDERSON./
•� �' No. /QE 9 69 ;�
, 1
♦Uxit '114. ,` ♦♦
1.000 c0.Lou
STEEL TANK
SEP7I!C U.S.C1IOtl
• MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW040107
Legal DescriptiontiERITAGE HILLS BLK 13 LT 3'
Design Engineer: 0014 Anderson Engineering
Owner Name: sam berker
Owner Address: PO BOX 111082
ANCHORAGE . AK 99511-1082
Date Issued: May 07, 2004
Expiration Date: May 07, 2005
Parcel ID: 015-221-15
Site Address: 012300 FREEDOM RD
Lot Size: 15000 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy ❑ Private Well ❑ Water Storage
All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By.
1/47 Date:
Issued By: ^� Date: Ch-hnf
Municipality of Anchorage
Development Services Department
Building Safety Division •
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. Permit Number SW
ca.Art\ it tCC1 z-1 : ssSl(p'-
Day phone 3'f S• 732 Co
Property owner(s)
Mailing address (1)
Mailing address (2)
5c•. B<-rktr
Pi U', Po, titoil-ArcrrJs-a
Zip Code
Legal description (Lot, Block & Sub'd.) C0 4 3 (3 (k_ '3 /1 rt t to kk / (S JJ
Legal description (Section, Township & Range) /9 3O0 F r -n t1 C'I o l� ed
Lot Size & aeft q.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
Well Only
❑ Water Storage
0
0
THIS PROPERTY CONTAINS:
Hot Tub 0 Jacuzzi 0
Swimming Pool 0 Water Softening Unit 0
Therapy Pool 0
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
/7-4,4thlvh,
(Signature of property owner or authorized agent)
Permit Fees:
`'f 3 0 . v c7 Waiver Fees:
Date of Payment: 'S/7/v zf Date of Payment:
Receipt Number: O S I (9 Q S / Receipt Number:
(Rev. 12/00) Cr 3
Michael N. Anderson, P.E.
Civil/Structural Engineering
4640 Shoshoni Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
May 6, 2004
Municipality of Anchorage
Department of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 3 Block 3 Heritage Hills Subd.
To Whom it may concern:
This is a request for an emergency tank replacement. The existing steel tank has collapsed and
need to be replaced now. The existing tank was within the 100 well radius, however the new
tank will be moved to outside the radius per MOA standards.
This new tank will not impact the neighboring properties due to the large lot sizes and layout of
the existing systems.
If you have any question please call me at 345-3377
Sincere) �J�yrjf
Michae N. Anderson, P.E.
PROPOSED
,,
I ,
_ ADJACENT SEPTIC
i
NEW 1C00 SEPTIC TANK-1 ' /\
i
1 -FREEDOMROAD-
r `
/
/
• • EXISTING
• •.
•
•
•
• 1
EXISTING TRENCH • I lik
. I
•
••
•
•
SHED
•
•
•
100'
WELL R
•IUS DRIVEWAY
LOCATION
WELL
HOUSE
OLD TANK
`
\�
`
Septic Design Prepared For
SAM BECKER
LOT 13, BLOCK 3
HERITAGE IIILLS SUBDIVISION
r/,
_����������
OF Az \
w.lsb;.•••••••:QS,�1l
-r4-...
(�
ri
5
i y; ,v
* • 49TH •'*
�I�
•• •• •••�
r I. 1".. MICHAEL N. ANDERSON 4;
• c •• C 469 '
( ri •. 'o,-
J �see ...,• `��_
l`\1�•� "��
Prepared By
MICHAEL N. ANDERSON, P.E./"••
4640 SIIOSIIONI DRIVE
(907) 345-3377 / FAX (907) 345-1391
;•••
SCALE: 1"=200' MARCH 5,
2004
DE 1TMENT OF HEALTH AND HUMAN SERI -S /
Environmental Health Division ‘,-J
0/3-- 02 a / /‘
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
A A-- .) °t'
TO
SEPTIC
ABSORPTION
Address
FROM
TANK
FIELD
WELL
/z37,v fi 4af/ ,A, ,4eil , /”--//
Phone(s)
Permit No.
No. of Bedrooms
WELL
8j
/e -o
31C-7374.
Y7vo 75'
3
1
LEGAL DESCRIPTION
LOT LINE
l O
7 O
.
Lot
3
Block
j
Subdivision
/Tn4E iq-i L(,SfOUNDATION
//
36
Township, Range, Section
/7—
. 2 AS -BUILT DIAGRAM (Show location of well, septic system, prope ty lines, foundation,
/� /„� g3t,i ...fez -Z z' driveway, water bodies, etc.)
TANKS
SEPTIC 0057i4., ■ HOLDING
Manufacturer
Capacity In gallons
57/64 5- z'1
/aDZ
Material
No. of Compartments
572x1.
7
TYPE OF
SYSTEM
0,
■ TRENCH • BED
X W. DRAIN ■ OTHER7[
+AI
Depth to pipe bottom from
original grade
Total depth from original grade '
-<---;.1
9-9
r
FT
7,7� FT
a
4
/A0
0
red/
d�L�
`
Fill above original
Gravel depth beneath pipe
a
added grade
`--6— FT
_3,5— FT
��6.
_
d
37'
+�
Ll
Gravel length
58 FT
Gravel width In
FT
/4/%F=,4Y
a N'
Total absorption area
Distance between lines
4
7('3 SQ FT
'�— FT
7oc'
N.
tire/
51
Number of lines
Soil rating
Pipe material
/
/ 5-.
2— SOFT
f8/o b-)03( d
s�
s...
Installer r
Date Installed
•�
WELLS
■ OTHER (Identify)
Igt PRIVATE ej(/S7%t(e/
Classification (A,B,C)
Total Depth
Cased to
7/1( FT
711 FT
Installer
Date Installed:
&-/G-71
f '55 bz/u/A
REMARKS:
( . 4 L}2/13 i/O i All / 4)J _ /�Ac/r%'7
t
/A/”- 5 p/ G7 rd//I �O pPG,e4e. Scale:
L[e/ /O Inspections
/syPer
Performed
-
by:
ENGINEER'S SEAL
J%
acs 4 Ai/p.-1
Date: LL
1et
Ace -4 �� certify that this inspection was performed according to all
in on this dale: �7/�/
Municipal and Stale guidelines effect
"1")://,/,,/-411:1-2
Date-
Health Department Approval: , _SC'
72-073 (3/85)
°
DEPARTMENT OF HEALTH AND ENVIRONMEN|AL PROTECTION
925 L STREET, ANCHORAGE, AK 99n01
264-4/20
PERMIT NO: 970075
DATE ISSUED: 05/12/
vir^��
^�e
APPLICANT: H.A. DAFOE / AECS
ADDRESS: 1�320 FREEDOM RD.
ANCHORAGE, AK 99511
CONTACT PHONE: J45-7326
LEGAL DESCRIP: SUBDIVISION : HERITAGE
SEC[IDN: 22 TOWNSHIP: 12N
LOT SIZ�: 15000 (SQ.FT. OR ACRES)
MAX BEDROOMS:
LOT:
RANGE: 3W
'
z*,X7;�w�t+~2;2 :�a2.0r
Listed below are the options available to you in designing your
system. Choose the option that best fits your site.
F.:,rdEAD 14= ��E<0..; IVA
DEPTH TO PIPE BOTTOM (FT.) 4"0 '..0
GRAVEL, DEPTH (FT.) 0.5 �.5
TOTAL DEPTH (FT.) 4.5 7.5
GRAVEL WIDTH (FT,) 19,0 5.0
• GRAVEL LENGTH (FT.) 36.0 50.0
GRAVEL VOLUME (CU.YDS") 2G.4 37,1
TANK SIZE (GALS> 1,000,0 ** 1,000"0 *:
SOIL RATING (SQ^FT./BR> 152 152
** TANK MUST HAW AT LEAST TWO COMPARTMENTS
certify that:
1. I �m familiar with the requirements for on-site sewers and wells as set
forth by the Municipality o[ Anchorage (MOA) and the State o�`Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o[ this permit,
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum o�
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING COD�S,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2),AS-BUILTS
WILL NOT BE APPROVED WITTlOUT AN ELECTRICA| INSPECTION REPORT; AND (3) THF
ELECTRICAL WORK MUST BP I"—.1E BY A LICENSED ELECTRICIAN.
SIGNED
�
APPLICANT: ..
ISSUED BY
,.~
DATE:
tef7
A ___�_
CONTROL bLt Vi'r uv...
• 1200 West 33rd Avenu., Suite 6
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NOOF
/
/
.e4 -d DATE S/7/e- 2.
CALCULATED BY
CHECKED BY
SCALE
DATE
/ resf . /Y 1324, .
:/Y� A/�� ;7174 = 4/3f a
afe i, ,•de x Y2 -'',:r..2 -,e/
q (, t) ,--..5/6 91' oY- 4/ 7 7C7 MUNICIPALITY OF ANCHORAGE
6., s C ,s 3 ' S`-2 5414C-4
ENVIRONMENTAL SERVICES DIYI31Oy
M4Y 3 2987
-/ S Ai., de = 3 / .-ICJ/ . , ., r- 93
7bP o 5.l°Ld )z*c /Pp (UoivM ELt' �:
Wk in 57 , 9`12 -
'Do hoz Y'ewtart G%u• 0s e re -e. S
P-42-6.404. e � e� e n S -z //a 7 e.,-, O_ F bia ve.r.r, ura, 74,
744 'e /c/5 0/d S S e", /a6 /ed /6 year
S
MUNIO0,1_11Y OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
MAY g 187
RECEIVf-
SYS
K ..OF, A 4 4.
4 r.. 74 et 40
4 i * :'49 i ; ' `�'c`j•
.
1.)o: r r ,..r. .....:...:1 30,
.— .�— -- -- 1 A
0
0
.ti
NI
0
OO
ti
N
• CONCRETE BLOC(
17.1
Q to
O O -.
O
1a...
O
oi -al el
rrilis
CONCRETE BLOCK WALK
NOTES:
i. NO TITLE ..SEARCH -WAS MADE FOR THIS SURVEY.
RECORD ZNFORMATIONWAS :TAXED FROM PLAT No.63-41.
2. NOTE THEFOLLOWINGENCROACHMENTS: THE GRAVEL DRIVE AND THE
WOOD POLE FENCE INTO. LOT -4 AND INTO THE RIGHT -A -WAY. THE
6' WOOD FENCE .:FROM ,-LOT -iO-INTO LOT 3.
3. DUE TO ICE THE GRAVEL DRIVE I8 ONLY IN ITS APPROXIMATE
LOCATION.. .
4. NOT SHOWN ON THIS SURVEY IS A WOOD POLE FENCE AND
FENCE LOCATED IN THE BACK YARD. BOTH OF WHICH ARE
BAD REPAIR.
AS -BUILT CERTIFICATION
I HEREBY CERTIFY THAT I HAVE
SURVEYED THE DESCRIBED PROPERTY
HEREON AND .THAT NO VISIBLE EN—
CROACHMENTU EXIST EXCEPT AS
INDICATED.
EXCLUSION NOTE
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 CIRCUNBTANCEB SHOULD
ANY DATA HEREON BE USED FOR CON-:
BTRUCTION OR FOR ESTABL.IBHINB
FENCE OR BOUNDARY LINES.
OF 44 1114
® ;49TH .ra
••.•�
c+ S
2737
Bryon E. �.o. r ,•0 0 >
•si•• No.154133 ;" ',o W•o. 07 -04 -Di BRIO
' 9pFFSSIONi� 41.
A WIRE
INMU1 IgALITY OF ANCHORAE
•
ENVIRONMENTAL SERVICES DIVISION
MAY 81937
am= '
4,a/aa•F0It4OF 11
COOPER AND COMPANY
4501. NORTHWOOD`DRIVE
ANCHORAGE, ALASKA 9951.7
C907)248-1924
Alm 4/8/87 SCALE
DRAWN BEC
CK• JBC
l'EGM. DESCRIPTION LOT 3 BLK 3
.: HERITAGE--HILLSDN
PERFORMED FOR:
/)2faer
Municipality of Anchorage
or •TH
DEPARTMENT OF HEALTH & HUMAN SEM$r49'
825 "L" Street, Anchorage, Alaska 99502650
SOILS LOG — PERCOLATION Tis ~• ••• REiD
`I V. • CE -2251
LEGAL DESCRIPTION://e/`i/2s /T'// C I.43
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(FEET)
•
•
•
COMMENTS
7010 SO
qj/ •.
....• p •y/s0/S 9
DaI�.R`�lD�
Township, Range, Section: 7'2N a z
5//47
MUNICIPALITY OF ANCHORAGE
CSH) ENVIRONMENTAL SERVICES DIVISION
fne S�^�
CA/14)
MAY 81987
RECEIVED
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Dry
NO
S
L
O
P
E
Dale.
s/7/ T'2.
N
A
444
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
JO
!...
ip
o•
„ g
O•/2.
b:4 tr7
9fr /eo
o
'/
O •/b
i°°ra/f
'
• 47
•
r�
•r3
0 , /I`
a •/r
7° a`2 -f
°
/0
a 3,
m
/o
/ /
i
o
rr
t
PERCOLATION RATE 2
TEST RUN BETWEEN 3•
ea4 so, /yr a1i4,,�
(minutesnnch) PERC HOLE DIAMETER
FT AND %/' / FT
PERFORMED BY %, • (fie , r/ I CERTIFY THAT THS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE � /S 7
72-008 (Rev. 4/85)
Nor . . N. mi.
HEALTH DEPARTMENT• ,
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N° 691
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /)//lc;"
LOCATION %/-l- zii'm D
MAILING �/) f e x }-3?<r- PHONE?/�-
ADDRESS C �7 C
LEGAL DESCRIPTION / i i li7J ` /'/7L.5
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /eG`'C"
•
NUMBER OF //
MATERIAL S%C-[ A COMPARTMENTS C
S' r1C/CJ _S /c= -e=. /�.j2/.3/,-Y,/,c=/J /CL LIQUID ,,,/, -
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
/ / '
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH �" LENGTH ZZ DEPTH 7
LINING MATERIAL 4/("7,2 L'Y'X %�
NEAREST LOT LINE /_4 61(Je 3 -
DISTANCE FROM WELL 1/
BUILDING FOUNDATION —
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) jf SQ FT
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE
NUMBER OF LIN - DISTANCE BETWEE NINES TRENCH WIDTHTOTAL EFFECTIVE
TOTAL LENGTH
, OF LINES
ABSORPTI9t AREA
DEPTH: TOP OF TILE TO FINISH GRADE
SQ FT
LENGTH OF EACH
NE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN ABOVE TILE
WELL:
LOT LINE
TYPE , DEPTH 2)4
31/.4Er
SEWERSINE
SEPTIC
TANK
DISTANCE FROM
BUILDING FOUNDATION
i SEEPAGE
SYSTEM //-) , CESSPOOL SOURCES
WATER
SAMPLE ��i�i/�'/W NEAREST
OTHER
DISTANCES:
DIAGRAM OF SYSTEM
.1
f>/>/�7� p.' i'4,1*,F
-Zur T
. s �
I T.i
tea;.
DATE
9/7/
APPROVED > l ��/'Z,_ :e(-
HEALT UTHORITY
For}as : Harold
ryocation.9t._.3,t $look 3,...Heritag€ Hills
Date completed -!77-21:1P.
Depth of wellk eet .
size of easing .., 1 = I604;
Tistance to ater; ee ...........
Distance to water wluie pumping QFlet . at date
of 60 0 galipns per. hour -
Description of'Fgrniatioii;
Clays Viand;&Grafi Fel
Clay,Sand&GraV
Clay,Sarid&GrazF� _lard•
Clay.
-,`i d
#'OSS DRILLING :::;4'
IPAIEAH Q
133& INGRA P11. 279-2$4DEPT.ANC iORAGE,.ALASKA 995NRON!;741'6-04E
We advise you to attach this certificate to your 41.1114-
GRETER ANCHORAGE AREA BO tbUGH
PERMIT NO ��0g
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT
MAILING ADDRESS flf�'' -'" PHONE ,'fyV
INSTALLATION LOCATION 3`-i (2-��
LEGAL DESCRIPTION �G%
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH l'f-- TO BE INSTALLED BY-Jf'_�./"
SOIL TEST RESULTS ��7��//v`.--" `('-772 ��'� /�"�'�2-)NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED 7
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
�D J
moi%✓//✓:: ._SO/4-
S/�%� d/Zi 'O
TYPE E'�'N��/'�"- SEEPAGE AREA SIZE �'-� TYPE "%7��. ✓<�/•�/ S
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ,moil DRAIN FIELD
/
/sl
SEPTIC TANK TO SEEPAGE PIT WALL
/
SEPTIC TANK sI SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT /42&7j
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
-
DRAIN FIELD
SEPTIC TANK, �S SEEPAGE PIT
TO RIVER, LAKE, STREAM.
SEEPAGE PIT
/ GJ
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 AUTHORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
/y
1 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 SIGNATUREC `��� \ � e
,5,
CREATER ANCHO:
HEALM DPAFTMENT
327 EAGLE STREET
ANCHORAE, ALASKA 99501
CASE
Legal Dcscription: Lot il:o
Performed For
Date Performed _--?_j_L-2y 7/
..,_
:-undavi i-, jLe.(
This Form Reports az Soi.s i,og_ ___ , - •Percolat.3.6n Test
Depth
Feet
Chatiicteristics
--I
74e. se -'0; 14, Ad.
h 1412 ki 0411y/
ku/ // c /1)/94 e 6,66qt?
pe6Cle c e or/
Was Ground Water Encountered?
If Yes, At lint Depth
Reading Date Gross Time
Location Sketch
Ne Time Depth To H20
1 FircIMMIT `'a e i iitnute "'-"---
.„,,...,_,
Proposed Install:at:, on : Seera,:-e F' 4:t L----- Drain Field
2 ,
Depth Of Aniet. Ze
Dopth To .Roitor 01 lit Or Trench / ii
._,--------,...,-
, 2...-CZ---;2S(:2-:--a2,C;/a-----.---,---------------,—.
COMUNTS
Net Drop
...eecasotNeu-nrstrawmat,a,
Test Performed it,,,:_e_exAaL
Data Certified By:
Dat
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL \,2-'1, '7 /1 fl
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
5fr7/(1
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include 1 t, loc subdivision section,. ownship, ran )
,/L . 3/ ` , 3� r .� . 5 742 /.1);Se .
Location (address'ordirections���O� q1.511
(b) Property OwneF Telephone: Home iness
Mailing Address> _ D 1:ArY //C
(c) Lending institution Telephone
Mailib.g'Address • -
(d) Real Ete Compan y-arii) Qgec�t j/
Address
Telephone
(e) Mail the HAA to the following address: or: Check here 1, if hold for pick up.
List conta t person
/12,nd day phone number below.
7-572
2. TYPE OF RESIDE
Single -Family
Number of Bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public 0
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 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 (Rev 8/861 Front
5. 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 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 FirmC S .7-z‘ .c Telephone 7 5
Address /2 l-' /J 3.3 ' /7,-E 4-, 11-J � 3
Date t//°713-2
�_ ,�wawr►*1i
1
, •
:4;2. °°°°°° 1.6‘6$14%;;;(40
*•� $
`'.% CE -2251 v•'i`i�.
: ROY C. REID, JR. ;
14 ivakwtook.
6 DHHS APPROVAL
Approved orr/-6bedrooms by YlJ � Date L. (time /7/ /9g 7
Approved
Disapproved Conditional
Terms of Conditional Approval
drins
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates 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.
Page 2 of 2
72-025 (Rev 8/861 Back
MUNICIPALITY OF ANCHORAGE (Mow-(
21,0
OF PNG�gOSLCTy AUTHORITY APPROVAL (H
AA
NGENjP�EvtCCHECKLIST - FEBRUARY 1984)
264-4720
\9'°\4UN 1 � 19$1
A. WELL DATA
Well Classification
Well Log Present
Total Depth
Static Water Level
% If A, B,C, .E.C. Approved (Y/N)
Date Completed ��1 �/
Cased to ."2/4/
/
Casing Height Above Ground
Electrical Wiring in Condui
Yield
Depth of Grouting A
Pump Set At /95
Separation Distances from Well:
To Septic/Holding Tank on Lot
Sanitary Seal on CasingfN)
Depression Around Wellhead (Y/
29/
To Nearest Edge of Absorption Field o Lot
To Nearest Public Sewer Line ` r
Cleanout/Manhole
Water Sample Collected by ✓ . _.( Y
Water Sample Test Results ///r<14 /
l� / ; On Adjoining Lots ./.0e
; On Adjoining Lots
To Nearest Public Sewer
ToNearest Sewer Service Line on Lot
e
7{/ Date .0e
Comments
B. SEPTIC/HOLDING TANK DATA
7/ G//41
Size -Z/C10
Air -tight Cap
Date Installed
Standpipes
Depression over Tank (Y
Pumping/Maintenance Contract on File (Y/N)
No. of Compartments
Foundation Cleanout (Y/
Date Last Pumped /el/
Holding Tank High -Water Alarm (Y/N) C/�
Separation Distances from Septic/Holding Tank:
To Water -Supply Well r i
To Property Line
To Water Main/Service Line R`�C
Course
Comments
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2?'
72-026(11/84)
C. ABSORPTION FIELD DATA
f
Soils Rating in Absorption
Strasi
ta /52 Type of System Design - �/1 /IC-,
Date Installedc26 0 T Length of Field ;` o
Width of Field S f Depth of Field "/i 5
Gravel Bed Thickness ��i
Square Feet of Absorption Area lD 3 Standpipes Presen (Y )
Depression over Field (Y/ Date of Last Adequacy Test ��y' 9 )26d'.
Results of Last Adequacy Test 7-16‘d4
Separation Distance from Absorption Field:
To Water -Supply Well /M O To Property Line /C./
To Building Foundation .36 r To Existing or Abandoned System on
Lot /.5-4 f w' ; On Adjoining Lots .7.3 49 /
To Water Main/Service Line "S6 7 To Cutbank (if present) /71!"I2D
To Stream/Pond/Lake/or Major Drainage Course We
i
To Driveway, Parking Area, or Vehicle StorageLArea 52t
Comments A-l�.J-,,., Sgs ,,,, l,,s/_'/1. :0-0/g-7 ,t=-,-.:,
D. LIFT STATION
Date Installed
Size in Gallons �jJ /� Manhole/Access (Y/N)
"Pump On" Level at �"'/K "Pump Off' at
Dimensions
High Water Alarm Level at
Tested for
Electrical Codes(Y�
Comments
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** 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 Date
Company
Receipt No
Date of Paymen
Amount; $
Page 2 of 2
72-026 (11/84)
MOA No
/UUP U UD 6
/
��:.� 0
0 . ,•ROY G RECD, J. o F
.•e CE -2251 "ss
e
. 7111::OLD SEWARD
ANCHORAGE, ALASKA
(907)344-8551
", •, ,• •., ,, ••—••••, •••• - UMW
HIGN%,,,e
99518
BACTERIOLOGICAL MATER ANALYSIS
5G(..
7KY L.U. V -5,51-
TO BE COMPLETED BY WATER SUPPLIER
FOR LAB USE ONLY
DATE COLLECTED
MONTH DAY YEAR
( Jo'-
TIME COLLECTED
AM
/2-an PM
TYPE, OF SYSTEM
0 PUBLC,®'INDIVIDUAL
0 RESUBMIT SAMPLE
Sample rejected because:
CHECK ONE OR MORE
0 Sample too long in transit.
Sample should not he over 30 hours.
I.D. NO. (PUBLIC' SYSTEMS CIRCLE CLASS
i 1 1 I 1 J 1 A B C ;Residential
RAMC `O3F SYSTEM TELEPHONE NUMBER
!� �',
5 3 / .C, i q r /4/I s
11 Sample received too late in week
SYSTEM ADDRESS
{
Free(L ., ee_)2 ci
• Not in proper container
❑ Leaked out
0 Insufficient information provided.
Please read instructions on form.
[3 Other (Specify)
CITY STATE ZIP CODE
.LOCATION WHERE SAMPLE WAS COLLECTED
41 I �Q
COLLECTED BY:(SIGNATUREI ' J
.., _,4---
RECEIVED FROM /
LCE' [ t(
TYPE OF SAMPLE
(CHECK ONLY ONE THIS COLUMN)
DRINKING WATER
CHECK TREATMENT
❑ RAW SOURCE WATER
❑ NEW CONSTRUCTION OR
❑ OTHER(Specify)
❑ CHLORINATED
❑FILTERED
OR OTHER
RECEIVED BY 'ii)j7Gc(i-fZ-, -
DATE 4-J(-?'7 TIME ..S .;,Z(;
ANALYTICAL METHOD:
/
[MEMBRANE FILTER
❑ FERMENTATION TUE_
Date & Time Started --
■UNTREATED
REPAIRS
Date & Time Completed 2v, r1 6-1-1?-7
IS THIS SAMPLE A CHECK SAMPLE
/
TO A PREVIOUS NON-CONFORMING SAMPLE?
PREVIOUS COLLECTION DATE
■ YES
LABORATORY RESULTS
Analyst -, iljr 7
ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM)
SEND REPORT T0:(PRINT FULL NAtIE,ADDRESS AND ZIP CODE
, i:. r
41' r NAME
_51/72
0 Other Bacteria
0 Test unsuitable because:
■ Confluent Growl:-
ADDRESS , 7-e'1.77" L"' 3 -3-1--,' 41',-F
0 TNTC
SATISFACTORY ET/' UNSATISFACTORY 0
CITYe .-: �r STATE ilk: ZIP ,' ✓ �
�,�'�, �i
BACTERIOLOGICAL WATER
FOR LAB
TOTAL COLIFORMSigll
ANALYSIS RECORD
USE ONLY
SAMPLE COLLECTION
Membrane Filter: Direct
Verification: LTB
Count --1 Coliform/100•.1
BGB
FECAL COLIFORMS
COTHER
READ
Fina; Membrane Filter
Reported By
Results Coliform,,/100m1
Date
INSTRUCTIONS ON BACK
Time A M
P.M.
OF FORM
?
/1/4
LABORATORIES
.4
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID # 92-0040440
)ATORIES
ANAL fSIS REPORT ST SAMPLE
FJ I -F Vt-.RSc-L
Ci 3frip1 t.).1 HE5A-1(2113E HILLS 1035 HRS
5affici 1 9 RE,c'd JUN 5 87
Ocie•;.'ect 6,/
ikf5ADDRESS 51
12.if) 441
5.la!sLr1s SAriRLE 5OLLISS TED L1 RECD S --4--51/16.355R5
OL-ir Order
I I. c,2n ki:-.C.Cunt
sate Repart
1' LE.
REPORTS ADDRESS
; Lai-) ;-)TIO I 1 ; 1 i X tdata=r
REF.,!..1;I:zUntts
Ni1RAFE-N ):59
• . — . . - . -
FEni-OniViC1 * spec -t&T tristu.ctiflEcibc,v&-.-
Nu= Nrs.,72 fjetecte,i See !iL Abov19 fe
fl.:7Afl
\61/4
it
P
ell. -6
1 r'n rI'r ' x
LABORATORIES
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID # 92-0040440
2/4
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
1. Approval Requested
Address:
oil)/ (-/ i�
Date Received /1—g-- 7. -
Time of Inspection %C)rA,244,(
Date of Inspection //-/7'
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATEP. FACILITIES
FOR
By:
2. Property Owner:
4,1.44 G t 6C
,
3. Legal Description:
4. Location:
5. Type of Facility to be Inspected: Alln,,c1v
Number of Bedrooms:
6. Well Data:
A. Type
62,
, �.-/t -,Guy ° /
"
C�Le
a/K.,
Phone : , 2 Cj
Phone : 7 — 6 73,)
jive ~
I0
B. Depth
C. Construction�J_.toyu1l�(_ D.
7. Sewage Disposal System:
A. Installed 7— 9.-
7l 8.
C. Septic Tank: 1.
l 7
Bacterial Analysis i/ //
Installer
Size /000 2. Manufacturer J
D. Seepage Pit: 1. Size 2. Material
77
E. Disposal Field: Total Length of Lines
8. Distances:
A. Well To: Septic Tank
, Absorption Area
1/ / , Sewer Lines
Nearest Lot Line .'l/ , Other Contamination
/4-
B. Foundation to Septic Tank / Absorption Area '�
C. Absorption Area to Nearest Lot Line
'Request for Approval of 'ddividual Sewer & Water Faeilitiz�
Page Two
5
9. Comments: -laze. az/ (`. e-tr ! /1. /2__ ee
ApprovedDate ////7/7Z_ -
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 located at:
Signed
Date