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HomeMy WebLinkAboutTIMBERLUX #2 BLK H LT 1TI*mberlux #2
Block H
Lot 1
#018-271-54
Municipality of Anchorage
Development Services
Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 Page 1 of 4
Www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW080119 PID Number: 018.271.54
—_ --- —
;meIllip YoungWastewater System: ❑ New ® Upgrade
_Z70-Manylell Ave.
ABSORPTION FIELD
Phone NumEer W BWrocme
D Do" Trrrcn ® ShMlow Trench D Bee D Mo D ovw:
LEGAL DESCRIPTION
Soe Rs°"9
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5 GPDT?
Depen to PPe Ixnt m ft. "a" proms
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Timbedux Add # 2
3.5 Ft.
5
Tomm�ip Ran(p 8eawn:
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F
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0 Ft.
30 Ft.
Well: ❑ NewGreM
❑ Upgrade
w+eRI
NumOsr of Mss Dnlsnp e.t.asn enee
GUue¢etron (Prints A B. C) Taw Dwm: Cosa to:
Existing private
5 Ft.
TOW Wsorp°onru
1 Ft
Pipe Metnw
Ft. Ft
Dr.IMr
150 Ft'
1114" HDPE
Dns Dnllse SUM WSW LMI'
Ii,imow
Dae Inswiw
pt
_Ft.
A + Home Services
8/712008
Yrow Pump Sn n Cnup Mpnt IUwe Grouts
C' Ft
TANK
SEPARATION DISTANCES
❑ Septic ❑ Holding ® S T.E.P. ® Other: Advantex
To
Septic
Absorption
Lift
Holding
umkYPnvate
Menutequrr.
cw tr
Prom
Tank
Field
Station
Tank
Se"rUna
Anchorage Tank/Orenco
1500 GM.
WNI
107'
113'
119'
...
91.01
Mnerrol
Steel
Numo.r of Cc._n is
2
sur,W.wn.r
100+
100+
100+
—
77
LIFT STATION
16.1'
10.2'
17.2'
—
250
n Fwi."
cw
Orenco
Fgrnenpn
16.3'
73'
...
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Inspections performed by: PANNONE ENG. SVC, LLC Dates: tM 81712008
Engineer's Stamp
4F e/•-
2nd 8118/2008
�.•��� .q�
Development Services Department Approval
: �,,• ♦0
Conditional Approval:`
Date:
•
♦ :Steven R. Po on i
♦1�
Reviewed and approved by:/ Date: O -O
No CE 819p •�
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PROP�SED UPGRADE: 1 0.1/' r •,
f 30LFX 5'W X , I.
OWED, 5' TD I 5%
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119
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PANNONE ENG SVC, LLC ��Date
P.O. BOX 102954 ANCHORAGE, AK 99510 (EOFAt,4`k) 10/31/08
7!q
PHONE (907) 272-8218 FAX (907) 272-8211S'�stole
i*:49n1 *� 1•_50,
•"' "• P•I.D. NO
Timberlux #2, Block H, L 1 _271-5Phillip N & Robin Young 1 Leven onno?t' / PERMIT NO.
s� . CE 81494940 Manytell Drive <f c SWO80119
Anchoroge, AK 99507 ��Is'fA� ••...•p` sheet
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NOTES: PAMONE ENG SVC, LLC Date
D
NOTES:
OT
RECORD ;5ZIp- OF ate
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 9951 kilt 09/12/08
wor S
o;-% .
PHONE (907) 272-8218 FAX (907) 272-8211 0. Scale
*:'49 L)-j NTS
P.I.D. NO
Timberlux #2, Block H, L 1 18-271-5
P
Phillip N & Robin Young t`,'e*ven A. *Pa'n*n*o*r;'e- PERMIT NO.
440 Monytell Drive CE 8149 S 0801 9
Sw080I 19
ILS
DETAILS Anchorage, AK 99507 40% ......... Sheet
3 0
OF 4
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
3. SCOPE OF WORK: 3 -BEDROOM HOUSE UPGRADE, NEW 15009 STEP TANK, ADVANTEX AX20 POD, NEW DRAINFIELD,
ABANDON EXISTING TANK PER CODE, RE -USE EXIST'D BED AS RESERVE.
4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE
INFORMATION ABOVE 15 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 8
FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY.
5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH
COMPACTED CLEAN EARTH MATERIAL.
4•
SLIDE SEi
OF 6"
OVER THIS CONNEI
TO PROVIDE
SHEER PROTECTION -
EXTEND TO
BRIDGE EXCAVATION
XRIARr
PUTA
BASII
PASSIVE
AIR
ADVANTEX SYSTEM FOR UPGRADE FIELD
DESIGN PARAMETERS ABBREVIATIONS LEGEND
UPGRADE SEPTIC SYSTEM CU COPPER
NO. BEDROOM: 3( 450 _w—"— WATER LINE/
TANK SIZE: 1.500gallon STEP DIP DUCTILE IRON PIPE WELL RADIUS
PERC. RATE: 6-15 MPI TH TEST HOLE
F
SOIL RATING: 5 gpd/SF C FOUNDATION CLEAN OUT _ BB _ BB _ EXIST'G SEPTIC
AREA ROD: 90 SF T# TANK CLEAN OUT NO.
SYS. TYPE: 5' -WIDE, 0.5'ED, C# CLEAN OUT NO. — e+ — es — NEW SEPTIC
MIN LENGTH: 18 LF M(/ MONITOR TUBE NO.
IdL R.I. RIGID INSULATION `^ CHAINLINK FENCE
30LFx5'WIDE,0.5'ED,1.5- TO DCO DOUBLE CLEAN OUT
TOTAL AREA: 150 SF DV DIVERTER VALVE
FS FLOW SPLITTER
T NOTES: PAMONE 1�7.T/V SVC,
T 1 n _��� �� Date
RECORD DRAWING P.O. BOX 1102954 ANCHORAGE, AK 99510 ��p'(E�FA�. 49, 09/12/08
PHONE (907) 272-8218 FAX (907) 272-8211 ..g. yl� Stale
49TH '•*/� NTS
.. ........ P.I.D. NO
Timberlux #2, Block H, L 1 / 18-271-5
Phillip N &Robin Young �, i'tev'eCE�8t49 rage% PERMIT N0.
4940 Monytell Drive �('�qs., � SWO80119
` DESIGN NOTES Anchorage, AK 99507�IIjD\orzssa>� sNaeoF 4
Inspection Report
Municipality of Anchorage, Building Safety Division
4700 Elmore Road
IN I'D a HELP (907, 343-0211
INSPECTION; VOICE (907) 343-6300 - FAX (907)249.7777 - WWW.Vrun,.org
i Nen1e same
Company Wt Bloc
Address 940 MANYTELL AVE
i Grid S%V3136
Wor�Subdivision T14.19ERLUX e2
C Daeerlptlon Septic tilt stetior.
P"t Toohniclan S TLUER. GRETCHEN I
Commante dr Dltootlons CW to reel on site
fI
I
(na WOn Type Electrcet:Retm Electrcal
Comments (!or Insaecior use eny)
$v-rT2�rC-.kL GInJA-t,.r
i
� Inep.cto► 1Z�i2t t��
I
SEP -9-2308 TLE 05:32FM 231
. P.1xi
Permit N C&5919
Inspection Dete ms4p.2008 PM
Prone 272.4591
LOT 1 UK TR n1a
PAGE: i
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
Upgrade
Permit Number: SW080119
Legal Description: TIMBERLUX #2 BLK H LT 1
Design Engineer: 0062 PANNONE ENGINEERING SERVI(
Owner Name: PHILLIP & ROBIN YOUNG
Owner Address: 4940 MANYTELL AVE
ANCHORAGE. AK 99516 -
Date Issued: Jul 08, 2008
Expiration Date: Jul 08, 2009
Parcel ID: 018-271-54
Site Address: 004940 MANYTELL AVE
Lot Size: 33142 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑� Disposal Field [?] Septic Tank Holding Tank [:] 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:
Issued By:
Date: / O"
Date:
\ Municipality of Anchorage
Development Services Department
P
Building Safety Division
t P
i On -Site Water and Wastewater Program SP ,;
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. N g -1Z 1- !i
Property owner(s) Phillip & Robin Young
Day phone 360-941.2636
Mailing address1600 Woodroe Ln, Anch AK
Zip Code 99516
Site address 4940 Manvtell Ave
Zip Code 99516
Legal description (Sub'd., Block & Lot)
Timberlux No. 2. Block H, Lot 1
Legal description (Township, Range & Section)
Lot Size_ '331 LI P. Sq. Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR (® all that
apply):
THIS APPLICATION IS AN:
Absorption Field
®
Initial
❑
Septic Tank
®
Upgrade
Holding Tank
❑
Renewal
❑
Privy
❑
Private Well
❑
Water Storage
❑
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.
Pannone
LLC
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: �� Date of Payment:
Receipt Number: 55592 Receipt Number:
(Rev. 11/05)
Pannone Engineering Services, LLC P.O. Box 102954
Consulting Engineers Anchorage, Alaska, 99510
(907) 272-8218 (907) 272-8211 Fax
June 20, 2008
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Timberlux No. 2 S/D Block H Lot 1
Septic System Permit Upgrade Request
Ladies and Gentlemen:
I am writing to request a permit to construct an upgraded septic system be issued for this property. The
proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The lot is
served by a private water wells that is located along the western property line. The existing septic system is
in failure and will be left in place to be reused. The surrounding developed lots are served by private water
systems. The private wells are located over 100 feet from the proposed soil absorption system.
1. Soils. A single test hole was excavated in June of 2008. See the attached soil log. Ground water was
monitored for over seven days and the test holes remained dry during this period. Bedrock was not
encountered in the test holes. It is my opinion, based on the results of the percolation tests and overall soils
appearance; an application rate of 5.0 gallons/day/square feet should be used, using an advanced treatment
system with an auxiliary pump vault.
2. Reserve Soil Absorption System Design.
a. Percolation Rate: 9 Min Per Inch
b. Application Rate:
c. Design Flow:
d. Min. Absorption Area:
e. Total Depth:
f. Effective Depth:
g. Width:
h. Minimum Length:
i. Design Length:
j. Effective Absorption Area:
k. Septic Tank Size:
5.0 gpd/sf
450 gallons per day
90 sf
4feet
0.5 feet
5.0 feet
18 feet
30 feet
150 sf
1,5 0 gallon STEP w/Aux Pump Vault & AX20 Pod.
3. Surface Water: There is no surface water within 100 feet of the proposed system. There is a creek
running along the western property line. The proposed drain field upgrade will maintain at least 100 feet
from all surface water and drainage ditches.
4. Topography: The average topography in the area of the proposed septic system is approximately
twenty five percent based on topographic information. The proposed installation will be greater than 50 feet
from the shoulder of the steep slopes.
Page 2 of 2
S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no wells or septic systems within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Seven R. Pamone
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
W:\PES Work Files\Letters\Timberlux No 2 Blk H Lot 1 001.doc
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01FP.O. BOX 102954 ANCHORAGE, AK 99510 C� • ' �qs+`�� 07/o3/os
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 ig�p'• �y+) Scale
TH * 1'=100'
•• 9 '••%P.I.D. NO
Timberlux �/2, Block H, L 1 -1 1 19-271-5
Phillip N & Robin Young en . arno�e j PERMIT No.
.•. CE 8149 j SWxxxxxx
4940 Manytell Drive
PLAN Anchorage, AK 99507 (fit, g7p S4ci1�� Shet
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PROPOSED UPGRADE: 1 I O
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0.5' ED, 5' TD
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NOTES: PAMONEM ENG
SVC, LLC; -'OF A� 1 07/03/08
P.O. BOX 102954 ANCHORAGE, AK 99510 „�p�� - � � � ' )
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 �•• �Sf9 e
'�� scort•
�••• •••� P.I.D. NO
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•• n annoae
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/
49gll Drive Sheet
PLAN Anchorage, AK 99507 ..oF 5
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NOTES: PAMONEM ENG
SVC, LLC; -'OF A� 1 07/03/08
P.O. BOX 102954 ANCHORAGE, AK 99510 „�p�� - � � � ' )
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 �•• �Sf9 e
'�� scort•
�••• •••� P.I.D. NO
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•• n annoae
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PAMONE ENG SVC, � ,� w .
P.O. 80X 102954 ANCHORAGE, AK 99510
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„�p��' AS?'�I1j
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07/03/08
Scole
ISSUED FOR CONSTRUCTION
PHONE
(907) 272-8218 FAX (907) 272-8211
' C ,49 *,�/
.... ... ....
'Po
NTS
Timberlux #2, Block H, L 1
P.I.D. NO
71-54
Phillip
Phillip N & Robin Young
teven k. none /
CE
PERMIT NO.
4940 Monytell Drive
Anchorage, AK 99507
8149 i
11 cs_�
�IIlk
5wxxxxxx
DETAILS
Sheet
OF 5
PERFORMED FOR:
LEGAL DESCRIPTION:
TEST HOLE 1
1
2
3
4
6
8
7
9
9
10
11
12
13
14
15
COM
PERF
WITF
SOILS LOG - PERCOLATION TEST
TOPSOIL
gravelly sands
SAND SILT
MIXTURES TO
SILTY FINE
SANDS
SLOPE
X TEST
HOLE
J WAS GROUND WATER
ENCOUNTERED?.N
IF YES. AT WHAT
DEPTH?
DEPTH TO WATER AFTER
MONITORING? -DRY -
DATE: 6/12!08
�A?slo!�
V,0Lt 61 a t �ct�tl
e
(ISSUED FOR CONSTRUCTION I
TEST HOLE 1
TH 1
READING DATE
CLOCK
NET TIME
WATERTIME
LEVEL
READING
NET DROP
1 6-5-06
11.11
a1rY
0'
2
1141
30 MIN
133/6'
3.9'
3
1145
a1rY
w
4
1215
30 MIN
127,1'
34'
5
1218
a Ird'
0'
6
1246
1 30MIN
127,1'
34'
ROLATION RATE 9 (miMnch) PERC HOLE DIAMETER 6Inches
ST RUN BETWEEN 6 FT AND 7 FT
rprises. Test Hole was presoaked before perc test.
S TEST WAS PERFORMED IN ACCORDANCE
3FFECT ON THE DATE OF THIS TEST.
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
Timberlux #2, Block H, L 1
Phillip N & Robin Young
4940 Manytell Drive
Anchorage, AK 99507
-�% 07/03/08 9+1 Scale
NTS
•••••P.I.D. NO
-271-5
n V48r;' % PERMIT NO.
CE 8149 .•,�� SwxKxxxx
�G Sbeet
4 OF 5
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
3. SCOPE OF WORK: 3—BEDROOM HOUSE UPGRADE, NEW 1500g STEP TANK, ADVANTEX AX20 POD, NEW DRAINFIELD,
ABANDON EXISTING TANK PER CODE, RE—USE EXIST'D BED AS RESERVE.
4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE
INFORMATION ABOVE 15 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 8
FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY.
5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH
COMPACTED CLEAN EARTH MATERIAL.
4' JIM
4' PUMP
SLIDE SECTION
OF 6' PIPE
OVER THIS CONNECTION
TO PROVIDE
SHEER PROTECTION -
EXTEND TO
BRIDGE EXCAVATION
2EA.
XILIARI
Puui
BASO
ADVANTEX SYSTEM FOR UPGRADE FIELD
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
NO. BEDROOM: 3 (450 gpd)
TANK SIZE: 1,500 gallon STEP
PERC. RATE: 6-15 MPI
SOIL RATING: 5 gpd/SF
AREA ROD: 90 SF
SYS. TYPE: 5'—WIDE, 0.5'ED,
MIN LENGTH: 18 LF
USE:
30LFx5'WIDE,0.5'ED,1.5' TD
TOTAL AREA: 150 SF
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
MN
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
NOTES: PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211
Timberlux #2, Block H, L 1
Phillip N & Robin Young
4940 Manytell Drive
DESIGN NOTES Anchorage, AK 99507
LEGEND
--W—w WATER LINE/
WELL RADIUS
—
as — as — EXIST'G SEPTIC
as — u — NEW SEPTIC
O CHAINLINK FENCE
LDote
�� OF AC4sl0) /03/08
�P' le% NTS
W,n un
$teve'n�R �onnoie j PERMIT NC
CE 8149 ,� SWzxxzxx
5 OF5
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN UNICIP LITY F ANCIIORAGE
AND jai 101—
THIS
ar
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
My Day of _5L4.N Q, of 20gL by and between h'r e r
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY:" In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AW WTS), described as PA OCL IAAE){ located
�1
—r, w, 41.1
at 4a m, � Ajl Alf- R l a rk H L"I 1 Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AW WTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinaRer, "AMC 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of Ito, On
(S_.00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AWWTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
S. Alterations, installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AW WTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AW WTS.
7. Noowaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner. nil er- I "It n VnTs kn'5
Anchorage: Purchasing Office
r
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of law. Any civil action arising from this Memorandum of
Understanding 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 Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
MUNICIPALITY:
By: U By:
Title:
Date: Date:
STATE OF A I Ai lx3 b ''� )
) ss.
TTIIRD JUDICIAL DISTRICT' )
The foregoing instrument was acknowledged before me this 'OLday of vtPi
/aSdM v
AR P 1C FOR AL, A
cfgoo on expires: S
�NO'\ �C
eW/N •O 1'�
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name p /
AK USM M e&41 i UA(IDA/
DISTANCES
0
TO
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
P6• &X X9/06/3 hVed 6613
Phone(s) Permit No. No. of Bedrooms
ZAP 8,70 / % -3
WELL
If
/0�
/
105
LOT LINE
o
yq
/k
I v'
/
r��
- 240
LEGAL DESCRIPTION
Lot
Block
/l
Subdivision..�
//MB�kLLfX
FOUNDATION
Township, Range, Section
/I ��
]fit[ 1-/ S&e,
AS -BUILT DIAGRAM
driveway, water bodies,
(Show location of well,
etc.)
septic system, properly
lines, foundation,
TANKS S-CY99 / I '
SEPTIC// -/%'-r ❑ HOLDING
Manufacturer
CTI �%AAIK
Capacity in gallons
?t✓0
L
�
%
L
Y
Material
J ��r�
No. of Compartments
TYPE OF SYSTEM
❑ TRENCH BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from -
original grade
FT
Total depth from original grade
h
ONAU FT
Fill added above original grade
o9fA�� FT
Gravel depth beneath pipe
0.7 FT
Gravel length
y5' � y%FT
Gravel width ,�JJ
�� FT
G
tJE
K
lit
Total absorption areaDistance
61�r Ql T
between lines
{p FT
Number of lines
S0
Soil ratings
SQ FT
Pipe material
/8 20b3l
Installer O / 3
Date Installed
WELLS
PRIVATE ❑ OTHER (ldentiiv)
Classification (A,B,C)
Total Depth
/6 FT
Cased to
/b FT
Installer
ALrAJ �Ru�-►At
Date installed:
5'_"r�r9
c E 7
A
d
/° •f(
C
REMARKS: 0 &CA��
3 .s
D
/ • 7�
Stele:
Inspections
fF�GS
Performed
?jam
by:
ENONEEflS SEAL
an / hese a
I - certify that this inspection was performed according to all
Municipal and Stale guidelines in effect an this date:
Health Department Approval: Date: ' 3 —'/G
72-013 (3/85)
` I ITY nF AmCHORAU E:
' Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4720
4 -SITE SEWER & SEPTIC TANK & WELL PERM
SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons, Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4,0
feet requires insulation over tank(s):,
WELL: Log must he submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion"
INFORM D,H,
HOURS, CALL 343-4681 AND LEAVE A
THIS PERMIT EXPIRES 12/31/89 AND
CONSTRUCT PER ENGINEERS ATTACHED
!NEER, IF AFTER OFFICE
MESSA8E.
VALID FOR A SINGLE FAMILY HOME.
APPROVED DESIGN.
I CERTIFY THAT:
1. 1 am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of 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, 1 understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is 3 bedrooms and
any enl1argement will require an additional permit.
�
���/��
v/�^�o U/�//
Permit Number:
99()173 Upgrade
Date Issued:
08/24/99 Engineer Designed
Signed,
DATE:
.�����
��^�����7
�����
(Owner)
ALASKA U^S"A,
FEDERAL CREDIT UNION
issued By:
Owner Name:
ALASKA V.S.A^ FEDERAL CRE[>IT
UNION Day
Phonem
Owner Address:
P.O" BOX 196613
786-2750
ANCHORAGE, AK 99519-6613
\
\
Parcel Id:
018-271-54
------
LoL Legal:
Subdivision: TIMBERLVX SU8D`
#2 |o+: 1 Block: H
Section: 34 Township: 12N
Range: 3W
Lot Size
33142 (sq,ft. or acres)
Max Bedrooms:
This Permit: 3 Total Capacity:
3
SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons, Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4,0
feet requires insulation over tank(s):,
WELL: Log must he submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion"
INFORM D,H,
HOURS, CALL 343-4681 AND LEAVE A
THIS PERMIT EXPIRES 12/31/89 AND
CONSTRUCT PER ENGINEERS ATTACHED
!NEER, IF AFTER OFFICE
MESSA8E.
VALID FOR A SINGLE FAMILY HOME.
APPROVED DESIGN.
I CERTIFY THAT:
1. 1 am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of 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, 1 understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is 3 bedrooms and
any enl1argement will require an additional permit.
Signed,
DATE:
.�����
��^�����7
�����
(Owner)
ALASKA U^S"A,
FEDERAL CREDIT UNION
issued By:
DATE:
A
`cs ALASKA RUIROf1R nTAL COnTROL SCRUICCS, IN.
a 6n9ineerinq & 6nuironmenlal Studies
SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM
LEGAL DESCRIPTION: LOT 1, BLOCK H, TIMBERLUX SUBDIVISION #2
1.0 GENERAL
1.1 The Drawings, sheets 1 thru o, shall be part of
this specification.
1.2 All materials and workmanship shall meet the
requirements of the Municipality of Anchorage,
Department of Health & Human Services (DHHS), the
conditions of the permit, and all applicable rules
and regulations currently in effect.
1.3 All excavations and depths are advisory, and are
to be verified or modified in the field by the
Engineer or inspecting agency.
1.4 It is the responsibility of the property owner or
installer to adhere to approved design for the
installation, to maintain the specific separation
distances and to have the appropriate inspections.
1.5 It :is the responsibility fo the property owner or
installer to report to the engineer any observed
conditions which would put the system in violation
of state or Municipal regulations.
1.6 If the installation is not inspected by an AECS
engineer, AECS will not be responsible for the
installed system. An engineer at AECS should be
consulted prior to construction, to determine the
number of inspections that will be required and to
explain what these inspections will involve.
2.0 SEPTIC TANK
2.1 The existing septic tank may be used, if it meets
the capacity requirement for the, residence and the
approval of DHHS. If not, then specifications 2.2
through 2.6 apply.
2.2 The, septic tank shall be a UPC -approved
two-compartment tank, constructed of 12 gauge
steel with bitumastic coating and set level on
undisturbed soil. If the tank is buried at a
depth of 4 feet or less, it must be insulated with
an overlying layer of 2 inch burial type
polystyrene rigid board insulation.
1412 W SC 33120 Avenue 0 AnchoRAGE, AlaSkd 99503 0 (907) 279-5553
2.3 The septic tank shall be a minimum of 5 feet from
the house foundation, and a minimum of 5 feet from
the absorption area.
2.4 The septic tank and bed shall be a minimum of 100
feet from any private well or body of water, 150
feet from Class "C" wells, and 200 feet from Class
"A" or "B" wells, unless otherwise specified.
Less than the required separation distance must
have prior approval or waiver by DHHS or Alaska
Department of Environmental Conservation (ADEC).
2.5 Piping shall be fritted with a mechanical
watertight Calder coupling on the outlet and inlet
of the septic tank. Inlet piping shall be 4 inch
solid PVC ASTM D-3034 or cast, iron, sloped
a minimum of 1/4 inch per lineal foot. Outlet
piping shall not be less than 1/8 inch per foot
slope. If the piping is buried at a depth of 4
feet or less, it must be insulated with an
overlying layer of 2 inch burial type polystyrene
rigid board insulation.
2.6 Cleanouts shall be installed as designated and
capped with air -tight rain caps (Jim Caps or
equivalent), and extend a minimum of 1 foot above
ground level.
2.7 If a lift station .is required it shall be a.
combination lift station septic tank per Anchorage
Tank and welding, Inc. design. Specifications and
design drawings are on file with the Municipality
and the, engineer.
3.0 SEEPAGE BED
3.1 The sand shall have an effective size of 0.4 to
0.6mm and a uniformity coefficient of not more
than 4.
3.2 The gravel for the bed shall be 0.5 to 2.5 inch,
screened rock with less than 3 percent passing the
No. 200 sieve. All substitutes must have prior
DHHS approval.
3.3 The bottom of the excavation shall be level and
raked with the backhoe blade to insure that the
bottom has not been compacted during excavation.
3.4 The distribution pipe shall be perforated 4 inch
rigid PVC with a minimum crush strength of 1500
pounds and shall meet the approval of DHHS for use
as drainfield pipe. All pipes shall be laid level,
and spaced according to the drawings.
3.5 Monitor standpipes shall be placed as shown in the
drawings. They shall be 4 inch rigid PVC ASTM
D-3034, or cast iron. The section shown with
holes may be either drilled 0.5 inch holes on 6
inch centers on opposing sides of the pipe, or a
section of regular perforated sewer pipe may be
clamped to the solid section with a no -hub
coupling or solvent joint. The perforated section
of the monitor tube shall be located in gravel
only. The portion of pipe above the sewer rock
shall be solid. A rubber raincap (Jim Cap or
equivalent) shall be placed over the top of the
pipe.
3.6 If the final grade over the bed is less than 4
feet above the gravel, insulation is required,
using burial type polystyrene rigid board
insulation. There shall. be 1 inch of insulation
for every foot of soil less than the required 4
feet of cover, but there must be at least 24
inches of soil even though insulation is used.
The solid pipe extending from the septic tank to
the drainfield shall also have a minimum of 4 feet
of cover or an equivalent layer of insulation
combined with soil.
3.7 if insulation is not necessary, then the gravel
must be covered with a layer of a nonwoven fabric
(such as Mirafai, Fibretex 200 grade, Poly -Filter
R, or equivalent).
3.8 The top and sides of the bed shall be planted with
a white clover and red fescue mix, or with
Kentucky bluegrass.
4.0 INSPECTIONS
4.1 This bed will require a minimum of three
inspections. The first inspection will be of the
open excavation, to assure that the system is
installed in the proper soil strata, correct depth
and meet minimum specified design parameters.
4.2 The second inspection will be performed after sand
fill is installed, but prior to placement of
gravel and distribution pipes. This inspection
will verify that the filter is properly installed,
that it meets specifications and that it fulfills
the intention of the design.
4.3 The third inspection will be after placement of
gravel, monitor standpipes, and distribution pipe,
to verify proper installation and position of
pipes prior to backfill.
4.4 The inspection of the septic tank installation can
be incorporated with any one of the above listed
inspections.
4.5 The lift station will require either an MOA
electrical inspection or certification by a
licensed electrician, depending on whether the
building code applies to this part of the city.
0
PERFORMED FOR
LEGAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
oo..e ER'S SEAL)
Municipality of Anchorage n4w
�YN - DEPARTMENT OF HEALTH &HUMAN SERVICES825 "L" Street, Anchorage, Alaska 99502-0650SOILS LOG — PERCOLATION TEST. REID, JR,
AK u3.a /Eb c��/T "All tl
ON: L / 8 t! 7Z4f3ekLUX 42 TownIST- - P $eiL
e7H
-2251 cbc,�
DATE P�mAS+ee
Range, Section: T/7-•✓ 23,�j
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water AfterMonitoring?
t ■■■■EN■ – mom
Reading
Date Gross Net
Time Time
Depth to
Water
Net
Drop
S. 99 5-43- 5-3 /o }9/
&7 -, 5V
.13
y•
15-53-1003
67- .Ss
, /z
3.
003 - /3
, 67 -,5-6
S•
1/67-3- 33 \
G7
PERCOLATION RATE 7, r0 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BET EEN FT AND �• FT
h So1L t/17E� FI1� /0
�7r�1/.
PERFORMED BY: AEG5 A I K�^—�r •e AI CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ALASKA ENVIRONMENTAL ,DB Z-07- / ff/- ex # Titi6c;'cax z -
CONTROL SERVICES, INC.
.1200 West 33rd Avenue, Suite B SHEET No. of
ANCHORAGE, ALASKA 99503 CALCULATED BY DATE �"�% �9
(907) 561-5040
CHECKED BY DATE _.
PgOp�f A4101rc, GMm Mas 01111
ALASKA ENVIRONMENTAL ,OB '-67-1 `TihBzrwx
~ CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B SHEET NO. OF
ANCHORAGE, ALASKA 99503 CALCULATED BY 7¢ DATE fr`z�9
(907) 561-5040
CHECKED BY DATE
PPOp1Lf AL1 ces Irc, GMPI, Maa 011]1
B087I
)eEdise8 geib
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NOTE: &"�
This As -built shall/not be used for
any purpose`Qther than finan`cing-
requirements. Under no c'ircumstanc
should any data hereon be used for
'construction or for establishing
tounda'ry or fence lines.
401. I
35
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EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. LT Fj'V
AS -BUILT NO CORNERS SET THIS DATE
M
2
I hereby certify that I have performed a Mortagee's in-
spection of the following described roperty. Lc
Block A/ Tl�-6Gvl7y.x Su—L4
A/o. Z
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there- j
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Anchorage, Alaska
this --LE E 411 day of LAu h P 19.
FRED WALATKA & ASSOCIATES
Engineers and Surveyors _
N
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fil
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scot/e; /„4a' 1.
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oR SEDER s ll;i'Ms `,�Q� •� •.;9s� `
yRo70S�D a1PbRAD1 .00P:49T •.
;04.0.6 u• .•....
ot
t_ , % 1E Y C. REID, JR. l•
•'-.1 t>#S�io CE -2251
gy�Prolegssim�a�� -° a
01'L X 71
NOTE:
This As -built shall not be used for
any purpose other than financing~
requirements. Under no circumstances
should any data hereon be used for
construction or for establishing
boundary or fence lines.
..s
280...00 8`
ZSf'
)ec
s Fvn, Hse`
a
1 p � Ti;AIA
0 Aa�✓e�l
S epf?C
Vehfs
t{al� p
35
WEu. - 7
4a�la�t
\ i alEal sJ�u-
'- sxlrl,�Jb >zc�dcd
f1BArlD+•1 /
NBG °SS'O¢"-w /44, 99
t+ : sl.VTH �.
rp - Fred Wo'ofko..`�. e
EASEMENTS OF RECORD, OTHER THAN -
.THOSE SHOWN. ON THE RECORDED
PLAT ARE NOT SHOWN , HEREON. . LT �(.y
---- ------- _L
info 4A
� �if7 TA
z7 S N
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortagee's in-
spection of the following described roperty Lr, f Ii
Blor-k % Tip 6E,1uX Skbd.
A/O. Z
Anchorage Recording Precinct, Alaska, and that the improve.
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Anchorage, Alaska
this l S 1' day of L'A' vt P 19SL�
FRED WALATKA & ASSOCIATES
Engineers and Surveyors -
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOB LD! / �.'o;C_f L,� 77m,5r-XLUX -0�2-
SHEET NO. Z OF -
CALCULATED BY 74- DATE / 7-0
CHECKED BY nATF
PPOtlJC W � Iz, Crew, Mas 01411.
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
.1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561.5040
J013 �iJ / �i r. �H6E�PLtAt1
SHEET NO.
OF
S
CALCULATED BY
./
^`
DATE
CHECKED BY
DATE
HNDJCINI.l X. cf"' Mm pull.
'-WATER WELL "RECORD c
STATE OF ALASKA
DEPARTMENT OF NATURAL.RESOURES
Division of Geological & Geophysical Surveys
Drilling Permit No.
A.D. L. No.
Meridian
lo. Borough Sub)divislon ' Lot Block ib. 1 '/4 Or Section No. Township N Range E❑
1 I
Ic. DISTANCE AND DIRECTION FROM ROA TER9ECTION3 3. OWNER OFWELL' ,• .
/
�� C/JL�/vO ls�M�L`
IJP(
'Address:
Street Address a Well Location - -
2. WELL LOG Feet Below-
Surface
4. WELL DEPTH: (final)
S. DATE OF COMPLETION
-
- 4(0---tl
eqr 411
-8L- ,7*2 T...
' Material Type Top -Bottom
'
• -
l.
6• ❑Cable toopRotary, .❑Drlvsn "❑ Dug
11 Auger 77❑�S Jetted [3Bored ❑ Other:
e - -
?.USE: ® Domestic ❑ Public Supply C] Industry
,[L -J Irrigation ❑ Recharge ❑ commerical -,
❑ Test Well 13 other;
e- IV go--
S. CASING ❑ Threaded .[Welded
/_
dlam.ln. to /{ ft. Depth Welght_Ibs./1f.
77717-
diam. In. to ft.. Depth Stickup ft.
80
9. FINISH OF WELL'
Type: Dlom iter
• Slot ah Size: Length:
Set between ft. and ft.
Bockfilling Gravel pack
MI PAL1r( OF ANCHORAGE
DEPT. OF HEALTH & -
N
F
10. STATIC WATER LEVEL:' -V D _ft.
_
t -1499
❑ Above or ❑ Below land surface Date
�—
Equipment used:
r�
II . PUMPING LEVEL below land surface and YIELD
It.after / hrs. pumping—AZg.p.m.
ft. offer hrs.. pumping g:P.m.
- - - -
12.GROUTING Well Grouted: C]Yes C3No ".
Material: C]Neat Cement ❑ Other:
_ -
13. PUMP: (if available) HP
Length of Drop Pipe - ft. capacity - - O.P.M.
-
/0Subm. C]Jet ❑ Centrifical ❑ Other
" - 14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION: -
- 15. Wafer. Tem De ra taro _a C]F ❑ C
This well was driile oder yljurlsdicllon on this report Is true to the best of my knowledge and belief; -
" ' / Registered Business c me - - Contract License Number
Address'
•
Signed : ` f - Date:
ut or:ed RaplSsenlallve
Form 02-WWR (11/81) Copy Distribution: WHITE - Stole DGGS, PINK - Driller, -CANARY-Customer
It'—, MUNICIPALITY OF ANCHORAGE �..�.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
g Tom.
PHONE ry�j
37.7,)-
NEW
❑UPGRADE
MAILINGADDRESS
LEGAL DESCRIPTION
41
LOCATION
v
NO. OF BEDROOMS
U
DISTANCE TO:
Well %OU
.E
Absorption area
welling
PERMIT NO.
g� ��
Y
P
wf
Manufacturer fv
l7
Mate ial
No. of compartment
rn
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
�C7z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
2 z F
Manufacturer
Material
Liquid capacity in gallons
p
=
DISTANCE TO:
W f
O 00
Foundati n
%�
Nearest lot line
PERMIT NO.
T
D u z
Z w
_
No. of lines
Lengt of each line
.3 �.
Total length of lines
32—
Trench width
-^^ inches
Distance between lines
'
fL
F.
o
Top of rile to finish grade
l
Material beneath file
Total effective absorpt on, area
j�
w
Length
Width
Depth
PERMIT NO.
t7
Q F
wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
"t
m
DISTANCETO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
ci
Driller
Distance to lot line
PERMIT NO.
w
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER r
L F-
7. �Moel, l•
REMARKS L
SFS 07 c✓i
i
t K
P
P
ARTROVED,DATE LEGAL
72-013 (Rev. 3/78)
THE RF,-rt..IRED SIZE OF THE :=lilt.. AB_5RP,.l..I{_N :_?r'.,TEM IS:
_ _.
THE: LENGTH DIMENSION 7: `i: THE LENGTH ':: 'I P:! FEET) CIF' THE TRENCH ith C;ra i' f;F I ic:;_.i'.+.
THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEEN EEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION R IN FEET).
THERE 15 NO SET WIDTH F'!:=R TRENCHES.
THE GRAVEL C'[=iPTH IS THE MINIMUM DEPTH OF GRAVEL BET1ll...EN THE OUTFALL PIPE
i=1t+D THE. BOTTOM OF THE:. EXCAVATION (IN FEET). .
PERMIT APPLICANT HAS THE. RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION It,l.';iac•EC:.T'ItiN.. OF ANY Lit:iLLS ADJACENT '.3O THIS PROPERTY AND THE:
NUMBER OF RESIDENCES THAT. THE: WELL. WILL. SERVE.
EiEiC:E':I-'1:l_LIh.Ei OF HhJ's' SYSTEM L:..'i-u:__ri E=ir:,.._N•=;Pt-C:-r:EO! r��r: APPROVAL T 1
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
-
MINIMUM DISTANCE BETWEEN A WEII. 1=1ND ANY' ON-SITE _SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE: WELL OR 15EI TO 200 FEET FROM A PUBLIC: WELL.. DEPENDING
UPON THE T','j=E, OF PUBLIC WELL. �j
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE -,EWER LINE IS 25 FEET FIND
TO A t.;I.1t'MUNIT'' SEWER LINE IS 15 FEET.
WELL LOGS? ARE REQUIRED AND t'fU=:T BE RETURNED TO THE DEF-ARTMER._IF WITHIN 30 I;li_IIFS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS NTS MAY APPLY. SPECIFICATIONS AND _jt-intCCTN DIAGRAMS ARE.
AVHTL.AF.-'L.E TO J.P!_URt: PROPER INSTALLATION.
EON.
E E'er: ^ Rte: H E ='K ITT _201-11 -L `=: s sEv
I CERTIFY THAN
i.. I AM FAMILIAR WITH
THE: REQUIREMENTS FOR ON --'_;ITE, SEWERS AND HELL.:' AS E.T.
FORTH BY THE MUNICIPALITY IIF. ANCHORAGE.
._. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES,
T f_li'JDER'_,-fF-.IND THAT TI"'![: ON-SITE _EWER SYSTEM PHI' REQUIRE ENLARGEMENT IF THE:
RESIDENCE IS kFt'fl.i[>E.LE'1:1 TO INCa...II[iLT_ t'fC1RE: 'iF'tF?t,[ :: E:ECEF:E7CiM:+.
SIGNED
NED
ISSUED B
---------------------------------------
APPLICANT
_.--.__-._____.__.-`___.__._...-._.._.___.___..__----__-_._._......-__
yyk
61W .............
_.. ;n
-
a
DEPARTMENT i. -1F
HEALTH f, ! 4F., [, i; t,l ::' t h}._Il+:1
.a_.t': 1 . It...
PROTECTION
4
825 "L"
STREET, ANCHORAGE, AK. 9950-1
264-4720
.Z.. - E_
'K. .._a._
x,._1 -E L r_g hx,:0
C.1 c' _ _
- ; n=- p 4 F..
F?. c. _ K:�: m_
v
PERMIT
NO. 820133
1
APPLICANT .ICFlt
T '_;At'UEL T. FETES .IP
BOX _—..
ANNEX
IiCHrl-:
rAa:-E__sETFF_[i
LEGAL.
t...1. B-H I IMETERLU„ 02
LOT
SIZE 32000
SQUARE
TYPE OF
SOIL ABSORPTION SYSTEM
15: TRENCH
MlH'IMUM
NUMBER OF BEDROOMS S '-
SOIL
RATING C: ,l,;1
F...i-;%E:;'=:. -
125
THE RF,-rt..IRED SIZE OF THE :=lilt.. AB_5RP,.l..I{_N :_?r'.,TEM IS:
_ _.
THE: LENGTH DIMENSION 7: `i: THE LENGTH ':: 'I P:! FEET) CIF' THE TRENCH ith C;ra i' f;F I ic:;_.i'.+.
THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEEN EEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION R IN FEET).
THERE 15 NO SET WIDTH F'!:=R TRENCHES.
THE GRAVEL C'[=iPTH IS THE MINIMUM DEPTH OF GRAVEL BET1ll...EN THE OUTFALL PIPE
i=1t+D THE. BOTTOM OF THE:. EXCAVATION (IN FEET). .
PERMIT APPLICANT HAS THE. RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION It,l.';iac•EC:.T'ItiN.. OF ANY Lit:iLLS ADJACENT '.3O THIS PROPERTY AND THE:
NUMBER OF RESIDENCES THAT. THE: WELL. WILL. SERVE.
EiEiC:E':I-'1:l_LIh.Ei OF HhJ's' SYSTEM L:..'i-u:__ri E=ir:,.._N•=;Pt-C:-r:EO! r��r: APPROVAL T 1
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
-
MINIMUM DISTANCE BETWEEN A WEII. 1=1ND ANY' ON-SITE _SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE: WELL OR 15EI TO 200 FEET FROM A PUBLIC: WELL.. DEPENDING
UPON THE T','j=E, OF PUBLIC WELL. �j
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE -,EWER LINE IS 25 FEET FIND
TO A t.;I.1t'MUNIT'' SEWER LINE IS 15 FEET.
WELL LOGS? ARE REQUIRED AND t'fU=:T BE RETURNED TO THE DEF-ARTMER._IF WITHIN 30 I;li_IIFS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS NTS MAY APPLY. SPECIFICATIONS AND _jt-intCCTN DIAGRAMS ARE.
AVHTL.AF.-'L.E TO J.P!_URt: PROPER INSTALLATION.
EON.
E E'er: ^ Rte: H E ='K ITT _201-11 -L `=: s sEv
I CERTIFY THAN
i.. I AM FAMILIAR WITH
THE: REQUIREMENTS FOR ON --'_;ITE, SEWERS AND HELL.:' AS E.T.
FORTH BY THE MUNICIPALITY IIF. ANCHORAGE.
._. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES,
T f_li'JDER'_,-fF-.IND THAT TI"'![: ON-SITE _EWER SYSTEM PHI' REQUIRE ENLARGEMENT IF THE:
RESIDENCE IS kFt'fl.i[>E.LE'1:1 TO INCa...II[iLT_ t'fC1RE: 'iF'tF?t,[ :: E:ECEF:E7CiM:+.
SIGNED
NED
ISSUED B
---------------------------------------
APPLICANT
_.--.__-._____.__.-`___.__._...-._.._.___.___..__----__-_._._......-__
- - - .q°.;s #t � B a °ids=="-'-�[ _ €- 'ga"-,' s_:ss'- t--ii•$:��a t:--_t�=1E�#C;-�
owns, Iapomr t% rt_; i_r!i ; t #r`�Itr3idh si: . rt�trt:rse)ii
aa:: :s:`": 'Jv' 7rc-a:r`1'. Nt•N ,'a1.li"-if .�. 7 '.. ?toot
1- Vt� I -v
rVANY No mwoivi
P"ii'?'�_ri_i�t r •�;-ii`#7_i°C�_ 1. ;-t fr_i .tis r".QX :i'f!9_ IINHEX ;t3? .2{ -
ubcnrion
i ct3:�t 1_9 t' -ii TL#•�= T`L Eln �-� t_t?T .:C �` _«13f-ls'3 v.t,;tt_F»s� ��rj
C, -':p ) - is s
t; e=i flC U G Iic 1,4- Ii i' soft n$ f7p,prjon vark:" Cj-
f,:%%c�i--`-3'}^-P"— 'i_+�$ C--_�.i•�t =. t't•--ice_ _ t �}=�'3�4:1�=4.._ �_t.`-.vi^, •C�^_y --
T:$= L.TbAll IS ii4E L_-PlifN ON s: f. t_$= t:+"
t C� o rr{ tv 4 r:"att fi t R T' I r is ro, n C'__ rn N'r ;_n T#•t `_tI rot,
13:it71_m, nNo J'i �34rrr:43 s,,,e 7'!4: - .` f:: 4c.i rlr:N ern As rh
m # r
is mu a_ r 41 L� T''i i=s:tp
13::.i ffl IS # eI M E 110001 00708 7 08 1:.: !�f`R:t=i`s1'r_7 ,`-_•;= t � �`���#{ TiH'.'�
2ND riv, �::lt l j ut# 1.9-, f L=i',S FIVS t I l iti C I id s -:_S_ t
117'-I'•F=31`•d'� -> =-`= _ #t. s: S=,sv=8t...,€__tie-i`c_:
11519li w';se'tEFIswLIr`r' ro It-wt.t,414 !"#I'• Com`_' 4'rm,-;mr wpimli r
IX: t st"t t S•fi- _t .'_ 'r#CN 1. K> i3 r YO fS C ;. t'ts'+:sPCP r',' PVD t'0;
I- rt-tN!3:F,!,. t_S- 1,40E 3 t--1.lf.`-'03 1149T film by,,- with h '..`�-P=. s'N_
-- E.It..,t ' _= : f?` -j` '"='ms`s'_ Y Y t `tvj—` - t=ii':�
)-.?F7�#d': = „�:, rs�:ii 1.1 c t-3-tca i r I#'itit- rlw -779:':ted} JY% L ey FHP _
Fr �? :ii•3 T2s >7tI_ �_ •AjG jai r to pp:%cufidn
3! 0I01f tt4 ty't r21-y:*z dtti i 1•!:--iz" q s_• I._ :314D ;IN ' S F ': Y#7lt w t t' �i rt _ e'r'a irf3 [5
IOU FEET FOR At'7'I'•lAl' S,k=s_- OR %:aii rest 90 FEET FRANs J't#t� sa f�c�t t'� tidl�4P't�
POOL I C.
7'i$f EITYi DfUnN&A rRom H PRI:A0. 1•trt_t_ TO A PRIYArx SEWER UNG IS .o FEET RND
Yti 9t,'t}74i'S!it3fr`t .O—):=,R t_Iii I'.; ?•1 rs r.
WL-R_L LUfr; ;t7`°P ; OUCREV AND Muir sa x rtj;: #Ni D TO 1`14s_' CArt'821-mcmr 4I€T:- m 29 wvs
s: TIHE (40-1-
Or=
0_i_is r 1 k=s)iifi ?'tEilr'3 11TRY ii;3€'t_'s.�t Ii=ff F3T If37"i »F#e l f7fT=T�tJC't'ft DIRi.tRAHS All
r `# r i t- ;r=' 3`Y°t=°- f :% EE t=:E=:¥'`'#t_:�F-F. 7-t1,._
I t:�;✓TI�� r�r:T '
i_' C l � t�d4 L! I7�„ 4# C #"i i T;�a K:=4�ft L r�:�:t'bei 3 T� i s!F-' tai`! - �. C Tr 'mss-1•i�e":: .iii' 7L= t.#�1_te y 5=r'r a OR
HP.f i -R.. r'itRi l t_. IF"r`iL C t e t it"tf t ±lif 7"tts�
2: r WILL V -6-;:1_L rii`' IN Tw
3: I 1jNr3:=h" r"1try 1,88T T81 t?if jl tc a -;s ='�=.rrii #Ii'r' X tAfbla Ct i rt# t'#T IF T#
;�:='� Ctz-'=#•ti'>, t• �;:�t�2t iC�=t :=G Tt`d_!_tf_s-y (� i.�.r" r; lo-�i+E � c�£f t_tt_tir'z_
7�,��_ � :orf r •�-�'n_�� ' �• , •� €k - .r � p - - _ _ _ _ _ - _
I'
PERFORMED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION: n7
EPTH © _ I�Z pQa-I
1 '
2
3-
4
l9
5
6 'b
7
C'p �7mcesf'lf
8 '
D'•6
Gross
Time
9
0•
Net
Drop
0
10-
11
11
D b
12
d p
1-
13
bl '6
ra .
4
14,-
-15
15-
16
16-
17
17
18-
\°
a
19
QaAh O. Talbot tV
No. 406P
-I o °'verso
20
P�,�4®v
B�n�HOFESSION��
PERFORMED
72008 (6/79)
L.
DATE PERFORMED:
uf7
WAS GROUND WATERS
ENCOUNTERED?
L
ENCOUNTERED?
O
P
IF YES, AT WHAT - E
DEPTH?
fl_ SOI LS LOG
❑ PERCOLATION
TEST
SITE PLAN
Reading
Date
Gross
Time
Net '
.Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED BY:
FT AND FT
DATE:
]Box 13oov STAR mouwE A ANCH®RAGE9 ALASKA 99502
344-7714
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 740 Tee t.
DRILLED AT THE RATE OF P23.00 PER FOOT. (rt LL n-LctveL9 coed Poa oI ;23 )
PROPERTY OWNER %ejjen Devetopment. 349.6j691 ( Cly� Te4,eA )
LOCATION OF WELL SITE Lt. l ° u
'�°,&- T iL1� T, �V )(
DRILLER Pe, n�Le- Ctcutj o-,? ;.am/.zolt� � 't-na 1U"a�Ll✓e
WELL LOG:
0---d-24' J2oveC oyWi. 30'10 c-Lcty G.ifLdeA-
24 --- 79' SandoL ctAauet.
79--734' IEc,tdPaA- :4 cerizeru,ed vet. Sevetat trou.Ldvrz.
734-740' lilate%L )jeavana ji. ,)- g,;Laue,L lath Good clean com4e 1,jateh Beat(;Jta �12.auet
at 740 Peet. Shotairza a p&odacib an, oP 70 dPN artith 75 Peet oP wate)L 4tarzcla.rza in
cao uza aP (ro t tom. 3/4 l oA4e- 4u.Gnzevrz i lyte. ahau Ul he . iAto Led 70 Peet a"- bottom,.
MUNICIPALITY OF na:
Coati aP D&ZU-Ing,: 523.00 pe}L Poon: X 740 Peet: "3220.00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 3220..00
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART RRILLING WORKS
DATE Pltatr, 75th, 79002 o- S
SERVICE CHARGE OF IV,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
• MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services w
DIVISION OF ENVIRONMENTAL SERVICES w}{
343-4744 on -C15
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # CWQ —Q-1 l — HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
L_o>i fv� " �z TizA% e31J sL-2
Location (iddress orr)rpctions)
'Ak,: usA eectiif u�o�!
(b) Property�wner
Mailing Address %'�• �'ok /�/�(oy3
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone: (home) Business?Z -7-75�-;
Telephone
(e) Mail the HAA to the following address: (or check here if hold for pick up.)
List contact person and day phone number below:
f}EGS Pie,e '"P.
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms 3
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
-66,1_3
Note:.lf 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 legailty and status.
72025 (Rev. 7/8B) Page 1 of 2
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kMUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA)
UNICIPALICKECKUSRAG (FEBRUARY 1984
NVIRONMENTAL SERVICES D$421,=44 �/
Legal Description: A07,/ -5a ft a/hauax �
APR 2 a 1990
A. WELL DATA RECEIVED
Well Classification ���� If A, B, C, D.E.C. Approved (YIN)—W,4
Well Log Present ON) Date Completed &74 Yield
Total Depth Cased to Depth of Grouting N14
Static Water Level eb Pump Set At
i
Casing Height Above Ground "r Sanitary Seal on Casing( N)
Electrical Wiring in Conduit ON) Depression Around Wellhead (Y(9
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ; On Adjoining Lots 7r�
To Nearest Edge of Absorption Field o/ Lot I0 ; On Adjoining Lots
To Nearest Public Sewer Line N To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot '7 � /� /
Water Sample Collected by e13 A1J/R_/ ; Date
Water Sample Test Results
Comments 61 <zm c 7/9_ A-� Pe
Afl_M449�a5 _41 -
B. SEPTIC/HOLDING TANK DATA
Date Installed -�3% Size IA�"O No. of Compartments y
StandpipesY N) Air -tight Cap (Y N) Foundation Cleanout(0)N)
Depression over Tank (Y N Date Last Pumped N//ZA"
Pumping/Maintenance Contact on File (Y/N) AV ; for �✓/�
1`_
Holding T e J�rm (Y/N) N Temporary Holding Tank Permit (Y/N)
SEPARk . ,e r TAN M SEPTIC/HOLDING TANK:
To Wte$<}uappl To Building Foundation 7
"Ji0s *6 asp
To Pr perty Line
•89 i9b R/tlFaaea ai•9ii
To Wa r tStaitk/S4Mae",L'
To Streahiokd,,Lake,ory
2 .,✓t4r ;4 ..M1..
Comments
/_t'
Drainage Course
To Disposal Field
72-026 (Rev. 7/66) Front Page 1 of 2 _
,�, / S// '4�y
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Type of System Design No°t AAA J64
Date Installed
Length of Field
Width of Field y��
��r Depth of Field
0� U
Gravel Bed Thickness Bel
Square Feet of Absortion Area
7$ Statndpipes Presen(Y )
Depression over Field (Y/N
/ Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 10-5 To Property Line
To Building Foundation To Existing or Abandoned System on
/ r
Lot 3D ; On Adjoining Lots
i
To Water Main/Service Line ![1 '-,J- To Cutback (if present) 1411.4
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area S
Comments
D. LIFT STATION c� //
Date Installed / �Dimensions �>/A`' ���" 4-17-1 /
Size in Gallons �6,/ Manhole/Access�N) `
u
"Pump On" Level at/ "Pump Off' Level at 7 /
High Water Alarm Level at it Vent(ON)
Tested for Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes 6N) `
Comments /W&Jo,W r K .9 iFih/lo k1 7-.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verifie , or conformed to all
inspection.
Signed
(� 3
Company
C !r
Date
0� U
MOA No.
0�
Receipt No. ,�2Z 0/�z /Z17
%
Date of Payment - 2 o �D
Amount: $ 17,0106)
MOA and HAA g
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. ]/8B) Back Page 2 of 2
of this
is Seal
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`. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
LABORATORIES FEDERAL TAX ID #f 92-0040440
ANALYSIS REPORT BY SAMPLE fox Work Order # 21127
Date Report Printed: APR 19 90 @ 09:35
Client Sample ID:L1 BLK H TIMBERLUX #2 OUTSIDE TAP
PWSID :UA
Collected APR 16 90 @ 11:05 his.
Received APR 17 90 @ 12:00 his.
Preserved with :AS REQUIRED
Analysis Completed :APR 18 90
Laboratory Supexvle x :STEPHEN C. EDE
Released By G�
Special
Instruct:
Chemlab Ref #: 900947 Lab Smpl ID: 1 Matrix: WATER
Parameter Tested
NITRATE -N
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY LEE REID.
Client Name : A E C S
Client Acct : AKECSRP
P.O.# NONE RECEIVED
Req #
Ordered By : LEE REID
Send Reports to:
1)A ECS
2)
Allowable
Result Units Method Limits
-----------------------------------------------------
ND(0.10) mg/l EPA 353.2 10
1 UA -Unavailable
a=___=....e=-='==..............
TestsPerformed
See
Special Instructions Above
ND=
None Detected
See
Sample Remarks Above
NA-
Not Analyzed
LT=Less
Than, GT-Greatex Than
Time
APPLI( NT FILLS OUT UPPER HAt, ONLY
Time
Property Owner^
ir /- -�F- f /,
A� - . I . I I
Phone
I Pho
Mailing Address
Y
Zip Code
4?
Buyer
A� -
Inspector
Inspector
Inspec or
Address'0,
Zip Code
Lending Institution,
Phone
Address
Zip Code
Realty Co. & AgentPhone
Address
Zip Code
7/
Legal Description
DISAPPROVED
Street Location
A A��Iz
Type of Residence
DATE
ajQ Single Family
�j Multiple Family
No. of Bedroom
0 Other
Date Sewer Installed
Well To Absorption Area
Water Supply
Septic Tank Size gx-O 6
G/-62-
S) Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
-
El Community
For wells drilled prior to that date, give well depth (attach log
if available).
El Public Utility
Sewer Disposal
Individual
Year. Individual Installed:
• Public Utility
When Connected to Public Utility:
• Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspec or
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. Or :'-,%IT!l
ENVIRON.1,10i:A- ;
OCT 151982
RECEIVED
(-3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
DISAPPROVED
CONDITIONAL APPROVAL'
(—"' — 19
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size gx-O 6
G/-62-
Well to Tank
72023 (3182)
Co in a
October 2.0, 1952
Becharof Construction
Lejes Development
6917 old Seward Highway
Anchorage, AK 99502
Subject: Lot 1 Block H Timberlux S/D
Approval for the individual sewer and water facilities cannot
e granted until the following items have been completed -
The The top of the well casing sealed with a sanitary seal so
by that it is water tight.
1°
° The water analysis reuort needs to he submitted to this
office from the Chem Lab, 5633 B Street, for our. review.
° A four (4) inch cast iron cleanout needs to be installed to
the septic tanl: and/or leaching area.
Please notifv this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264_4.720,
Sincerely,
O -V% -W A /
Robert C. Pratt
,r Associate Environmental Specialist
/�/ RP206/p/MT