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Home My WebLink AboutBROADWATER HEIGHTS TR A LT 4A�voc,.� uxdev ULh%-IS 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231302 Work Type: SepticTank Upgrade Tax Code Number: 05013180000 Site Legal Address: BROADWATER HEIGHTS TR A LT 4A G:0253 Site Mailing Address: 12015 W SKYLINE DR, Eagle River Owner: SELLERS TERESA R Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 9/19/2023 9/18/2024 27518 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 4_0 /U0 � ��IM Issued By: Date: Date: l Z MUNICIPALITY OF ANCHORAGE Development Services Department 1`` F Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05013180000 Property owner(s) SELLERS TERESA Mailing address 12015 W SKYLINE DR Site address same Day phone 907 214 1730 Legal description (Sub's., Block & Lot) BROADWATER HEIGHTSTR A LT 4A Legal description (Township, Range & Section) Lot Size 27,518 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank X ❑ Upgrade x ❑ ❑ (D) Holding Tank F1Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: 2 Receipt Number: 0 3 d 5D Permit No. SP2 3 1?, QZ. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc SteveEng.com Broadwater Hts Tract A L4A SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current septic tank has failed- the seepage trench still functions. This lot is close to a half-acre and on private water well. No adverse impacts are expected from tank replacement. Easements are depicted on the lot. The slope is negligible in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet. 5 minimum between the tank and trench. 5 to property lines & 10 to house. 4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot soil cover. Tank & solid pipe must be set on well compacted, stable soil. No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel. 4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 from the tank positioned to provide cleanout access towards the tank and towards the absorption field. Manhole Riser required in 1 st tank compartment. All cleanouts must extend to at least ground level. In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. Insulation must be placed over any pipe installed under driveways or parking areas. Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, Sewer Service Line is minimum 2% slope. Septic Tank to be pumped every two years or when required. Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231302, Deb Wockenfuss, 09/19/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231302, Deb Wockenfuss, 09/19/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231302, Deb Wockenfuss, 09/19/23 GREA . _R ANCHORAGE AREA BORA JH h?jL_)LD Department of Environmental Quality 3330 C Street Lt_) -�� — Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ' as t• MAILING ADDRESS -/ ° PHONE3f 3 ZC i��—� �`/ LEGAL DESCRIPTION �1jj."" LOCATION - SEPTIC TANK/: g DISTANCE ` U FROM WELL MANUFACTURER `" MATERIAL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH TILE DRAIN FIELD: / l O DISTANCE FROM WELL �� FOU ION NUMBER OF LINES DISTANCE BETWEEN LINES NUMBER OF 7 - COMPARTMENTS LIQUID CAPACITY GALLONS. TOTAL LENGTH NEAREST LOT LINE_ OF LINES TRENCH WIDTH— IN. TOTAL EFFECTIVE 30/ ABSORPTION AREA /'� SQ. FT. LENGTH OF EACH LINE 1 DEPTH OF FILTER r DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE) /IN. ABOVE TILE `' IN. WELL: LA_)(?l �-t_r-A�ug t f_ �r v t_:mM–""' TYPE— -tt a CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE , SEWER LINE , TANK - CESSPOOL —, OTHER SOURCES APPROVED __ DISAPPROVED REMARKS DISTANCES: INSTALLED BY: -- SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: 11 �1�__ / r REMARKS: DATE Form EQ -032 4ti- 4 SEEPAGE SYSTEM_ DIAGRAM OF SYSTEM i Alf �Y Y, APPROVED G.A.A.B. DEPARTMENT HEALTH AND ENVIRONMENTAL lTECTION 2510 E. /JDOR RD., ANCHORAGE, HK. -.07 ' 276-2221 L-AE:t—L- ___ �� —��U� PERMIT NO. ( 7626] ) `4! J_�-U. SRB BOX 6�5 EAGLE RIVER ��45-]8]4 APPLICANT ' LOCATION SKYLINE DRIVE LEGAL L4 TRH BROADWATER HEIGHTS 5D LOT SIZE 24122 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: U. Ez- F=- -T- FA= :1L:1L L_ EEE N 1:3 -F "= ��-- f -i F;� F=1 -%o F= L_ I---- E: F=- -T��= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �� F�7�I� ��K ��= BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PRO5ECUTION, MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �� F= F;-:,, Cj Irl I L3 E: I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS SIGNED:_ _______________ APPLICANT NEAL KING ISSUED BY_ f l �� _ ___DHTE______7� � GREAILk AiiCiiowi w ",i;iA L'UIZUUGii Ue artment of environmental } p Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - I'I;RM,ATION TEST Performed for _�� Date Performed.lr�a `� rr''';, Legal Uescripttion Tr sf �.��1 r��_f .�. 1-�c�,e;�.�P,",;•1 60 This form reports: Soils 1 og Percolation test Depth Feet 1 JGL»t/y �'%l'1�' •f -O Si/�. SGrY�GI ��M%• .•.�• 2 3- 4- 5- 6- 7_ 8� 9- �-vw GrzCevefs 2urrn�l r� �u� /ZCvtrnG�. Gow l)')Ui5tu2� /vV2Ll C/2CtC.4'eic( �undain� Gc. /rlii2v2 G�mvund-' Off' Silk' aner l�bhl�. 5iz sr,c�ett�u(�. V. GrLuvel Gond Gv/;�% 6/fie �y-°rac��D�7 � 10 - �hChnL�v��cr� rfd dv�jrvund�r/ slope 12 - 1314 4:5- - K(_l In_nd IJ01 U�__ Was ground water encountered? ,� If yes, at what depth? (leading Date Gross Time Net Time Depth to Water Net Drop vercoiation rate minute. -Proposed installation: Seepage Pit Drain Field Depth of Inlet _ _ �Depth to bottom of pit or trench COMMENTS:.� .t�.��. h �.mi�22. �'�f n�+�n�4- v_�� a(2 ,7�rr^r ' . ln��r�- Performed Qy ..1��!:r�_s _.�.4Certified '�-L_Date �Mi� ,� i� 1971 Zt, TR Kc� it F. Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 6 $ �u CERTIFICATE OF ON-SITE SYSTEMS APPROV JUN 7 [015 Parcel I.D. 050-131-80 Expiration Date: `� " 1. GENERAL INFORMATION Complete legal_ description Broadwater Hts Tract A Lot 4A 'Location (site ss) 12015 W Skyline Drive, Eagle River, AK Current Property, gwner(s) Pannatier & Pellegrino Day phone 622-3344 Mailing address ! same Real Estate Agent ` Audrey Mason Day phone 622-3344 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: 'e:L Date: 7 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5A(p Date of Payment &01 16 Receipt Number//�� Q 5 3:a 11) COSA # 65C: 5/aW Date of Payment Receipt Number, Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER ��ss certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, 1&60 _orf,, edures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows tHat Iffe 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724 Eagle River Engineer's Printed Name Steve Eng Date 6. DSD SIGNATURE -1G System #1 Approved for System #2 Approved for 3 bedrooms. bedrooms. Sta"on W. Eng , Pi 6256 - v* Disapproved.`` . Conditional approval for bedrooms, with the following stipulations: ` By: Original Certificate Date: —7Y .2 The Municipali y of Anchorage Devlopment 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 Septic System Advisory Well Flow Advisory COSA bl. sheet 9-0-12.dm Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _Of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: eroaJu.Aeo- �c,-'-.A Z 464 Parcel IDO 50 /3 A. WELL DATA Well type P_ If A, B, or C provide PWS ID # Well Log (YIN)_ Date compieted ///�%7� Sanitary seal (Y/N) Wires properly protected (Y/N) Total depthft. Cased to_eft. j G� Casing height (above ground) / 2 in. FROM WELL LOG AT INSPECTION Date of test. Z Z Static water level _ ft.� ft. Well production 3. rg -f g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform ® colonies/100 mL Nitrate D+l tmg/L Arsenic tQ• : ug/L Date of sample: d' 4-/ fS Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sr i c Date installed elleyeIn' Tank size /&V(J gal Number of Compartments Cleanouts (YIN) Foundation cleanout (YIN) . Depression over tank (Y/N) AL High water alarm (Y/N) N Date of pumping 3 15 Pumper ,i 4it/i ndd!2 / Au vc Jw e i C. ABSORPTION FIELD DATA Date installed 6' F 7' Soil rating (g.p.d./ft2 or ftz/bdrm) / z 5 System type 7—reA U_ Length' 36 ft. I Width 3 ft. Gravel below pipe % ft. Total depth 042 ft. Eff. absorption area -Y-2-0 fe Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) __P_ For bedrooms Fluid depth in absorption field before testa in.. Water added Yso gal. New depth C( in. Elapsed Time: __I�,a min. Final fluid depth gCd in. Absorption rate >= SO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) A f If yes, give date D. LIFT STATION AIA Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at Datum in. "Pump off' level at in. High water alarm level at in. E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot / O O /i- On adjacent lots /D 6 `-f- Absorption field on lot /00 r 4, On adjacent lots 146 <f - Public sewer main Igo rr Public sewer manhole/cleanout 160 `,f Sewer /septic service tine 2 r $ f Holding tank r' Animal containment areas 1` Manure/animal Excrete storage areas /0O SEPTIC/HOLDING TANK QN LOT TO: Building foundation r f Property line O �r` Absorption field r Water main l6 t Water service line / d if Surface water 1/JO �f Wells on adjacent lotsG ABSORPTION FIELD ON LOT TO: Property line /a �fi Building foundation /O rf Water main lei rF Water Service line / a ` f Surface water /60 `f Driveway; parking/vehicle storage Curtain drain S� '� Wells on adjacent lots O G f F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. Engineer's Printed Name 7 cS�� Dateb L� COSA yellow sheet 2-6-15.doe Stoma W. tag Q, �n J y Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 151290 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 4A of Broadwater Heights Tract A Subdivision. This inspection revealed an arsenic concentration of 10.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Anchorage Recording Piecinct,:fitasxa andthat the improve. ra ants siti ated thereon are within the property tines and do not - gvertap or encroach on the prmp�rty lyingadjacentthereto, that no inaprovernents on prooerky tyln adiecent thereto en -roach _ on the premises in question and t9a4 €here .are no roadways, txai smission lines or other viMble.easements on said propertx - - except as indicated hereon. - Dated ,at ivag;ie River, .aiaska, - _fhts�_dayoi.�_'c.x.. SCALE - . Registered Land Surveyor NoAfs( �LS e 13 zx 77=0456, Eagle Sliver, Alaska 99y77 f S ona : {fK3T} 6942543 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services 1 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. # HAA # �--, C)<�'O 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4A; Txact A; Bnoadwatex Heightz Subdivision Location (address or directions) SkyUne Vkive (b) Property owner Mac. and Mu. Kent Telephone: (home) 694-2848 Business Mailing Address (c) Lending Institution Cay Mon gage Telephone 563-0700 Mailing Address .. 405 West 36th Avenue, Anchonaae, A.2azka 99503 (d) Real Estate Company and Agent TARGET REALTY/Bab Padgett Address P.O. Box 774627 Eaa2e Rivet. A.2azka 99577 Telephone 694-2388 (e) Mail the HAA to the following address: (or check herea if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 2. TYPE OF RESIDENCE ondened by Bob Padgett Single-FamilyXX Number of bedrooms —3 3. WATER SUPPLY Individual Well M 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 R Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 Firm " & S ENGINEERING Telephone ��-7 9 5� 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Date =G_ Y �ea.e •ter.. a��na •e��+d;'Y A.bwo A. Shefoe No. 14,574 424 0 0-01,0*00 AW 6. DHHS APPROVAL �% a Date Approved for J bedrooms by — Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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 orderto 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 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present(YYN) _Date Completed Yield S 6kft- Total Depth to o Cased to 1< Depth of Grouting `-14-- uck Static Water Level0-t- Pump Set At ti Casing Height Above Ground Sanitary Seal on Casing*)N) Electrical Wiring in Conduit (47N) !S/ Depression Around Wellhead (Y/M) ►--� SEPARATION DISTANCES FROM WELL: To Se tic/Holdin Tank on Lot 12-5 Septic/Holding g ; On Adjoining Lots � C_� 4- t To Nearest Edge of Absorption Field ZA Lot �� ; On Adjoining Lots J To Nearest Public Sewer Line ? , ToNearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot Water Sample Collected by `� S 11`i�-lr ; Date Water Sample Test Results Comments 'L% 1 B. SEPTIC/HOLDING TANK DATA Date Installed 6 Size 1�—z No. of Compartments '2— Standpipes Standpipes 6A) Air -tight Caps MN) Foundation Cleanout (Y/ tJ Depression over Tank (YAW Date Last Pumped -2- Pumping/Maintenance Pumping/Maintenance Contact on File (Y/N) �' ; for Holding Tank High -Water Alarm (Y/N) ,' Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: r r To Water -Supply Well �S To Buildin Foundation To Property Line U To Disposal Field To Water Main/Service Line A C:) -�- To Stream, Pond, Lake or Major Drainage Course 1 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed (42- - � �o Length of Field 'moo Width of Field �� Depth of Field Lk.- L2 1. t?tf) f ` Gravel Bed Thickness I Square Feet of Absortion Area 90 Statndpipes Presentc�N) Depression over Field (Yo J ►-, Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line I To Building Foundation �"'' + T E ' t' Ab d d S Lot a To Water Main/Service Line o U xis ing or an one ystem on On Adjoining Lots-'r'� To Cutback `if present) '� To Stream, Pond, Lake, or Major Drainage Course t To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in s "Pump On" Level at HighWater Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . _ "Pump Off" Level at Vent (Y _ **Check Permitted Bedroom Rating Against HAA Request" Pumping Cycles during Amu ccy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date.pf, lri s inspection.,�•M'�r'i',�p� Signed 5 & S ENGINEERING e Company 17034 Eagle River Loop (toad No. 204 age Kiver, Alaska 9957.7 Date 'Y 9 MOA No. g _ 151D :3 �A ote�yee� �W" o e $t �," ` t b neeks or n6 � A*bc i A. Shk 6w o �i to 1457'-E ice'' 1,,,;'„�,`"' Receipt No. Receipt No. —&, k'�, Date of Payment c9 Waiver Fee: $ Amount: $ % 76 Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 5. LEGAL D SCRIPTION E-CCDa9U_-_)%QAkV T / DAT e'vitCEIVED lo' INSPECTION APPOINTMENTS TIME TIME TIME DATE ❑ One ❑ Four ❑ Other DATE DATE INSPEC OR Three ❑ Six INSPECTOR INSPECTOR K INDIVIDUAL* GE ❑ COMMUNITY MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ❑ PUBLIC UTILITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC Wj$ONMENTAL PROTECTION 8. SEWAGE DISPOSAL SYSTEM 825 L Street - Anchorage, Alaska 99501 0* DEC 1 8 9979 ❑ PUBLIC UTILITY ENVIRONMENTAL SANITATION DIVISION NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Telephone 264-4720 RECEIVED CCEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE `. z MAWMG ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER � CX PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE I� MAILING DDRESS 4. REAL R/AGENT PHONE MAILING ADDRESS 5. LEGAL D SCRIPTION E-CCDa9U_-_)%QAkV T / lo' STREET LOCATION 6. TYPE OF KESIDENCE NUMBER OF,BEDROOMS AQ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY K INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM Q[ INDIVIDUAL/ON SITE** A7 f Z6 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) WV ((YY 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: OU0 If Tank is homemade give dimensions: SOILS RATING 1 21 S— TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer LineNearest Lot Line Absorption Area to nearest Lot Line 5. OMMENTS Qn^tt - n-4 m(, i",,_A _A " - ' [ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certifica e) ❑ DISAPPROVED DATE �— '�Lq• r � BY L 72-010 (Rev. 6/79)