HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 2 LT 7A
Municipality of Anchorage Page
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
Permit Number: ~8OHo~ PID Number: ¢/~' -,.~Z~,
Name: ~ ~y Wastewater System: D New ~gr~d~
Address:
lo~ L~ T~ P~ ~.,~k
ABSOBPTION
FIELD
P~-~', /~'-~O'~ JN°'°fBe~°°ms: ~ Deep Trench gShallowTrench~gMound
· ~le~ ~ Total Depth from originalgrade:
LEGAL DESCRIPTION ~,~oilRating: ~ GPD/Sq, Ft, J,~ -- ~ --
~%,.
SubdJv~Jon: Depth to pipe bosom from original grade: Gravel depth beneath pipe
Township: ~ JRange: ~ JSection: ~ Filladde~aboveoriginalgrade:..~2 ~ (~ea ~o~.Gravellength:
Gravel width: Number of lines: lDistance baleen I[n~:
WELL: ~X~ ~r~d~ / JO' Ft. ~~ ~ ~t.
Classification ~: Total Depth: ~ To: Total absorption area: Pipe mater)al:
o'"in't "
Driller: ~Drilled: Static Water Level: Installer:
Yi~M J Pump Set at: Ft. J Casing Height Ab°ye Gr°u;~: TANK
SEPARATION DISTANCES ~ s.ptic ~ Ho~.~ ~
TO Septic Absorption Lift Holding >ub~ic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~O~ ~ J
Number of Compa~ments:
Wel~ ~ool~ ~oO1+ ~o01~ ~ ECi~ Material: ~E ~
S~,a~e LIFT STATION
Water / O 0 l+ J OOl~ /~0 I~ ~
~ "P~p on" le~l at:J"Pump off" level at:J High water alarm at:
Cu~ain ~ Pump Make & Model J Electrical Inspections pe~ormed by:
Drain - N~t ~o~ ~ o5l ~ ~, ~.0,~,
Remarks: ~ L0( L1~E ~ ~s~ BENCH MARK
Location and Description:
~ ~ ~ ~'~ Assumed ~,evation:
E~~
- ~: 49~ ~111~
Inspections pedormed by: ~'~-~. ~ ~N~. Dates: 1st
Department of Heal. and Human~e~ices approval : ~:,~?.,,,.'
Reviewed and approved by: Date:/2-/~-~ ?~ :/.
72-013 (Rev. 9/91) MOA 25
PERMITsw980404NUMa~: AS'BUILT D~,WING PARCEL015_322_631D NUMBER:
_U~L/ -- __ 12,2_ 21.7 (APPROX. LOC.)~ /
DBL2_ - __12.3 ~2.0 ~/ / ~ ' ~ . /
ST2 -- 25 2 ~0 2 (APPROX LOC)
--- .... ---,~'~- · · '~ SAND FILTER
Mr2 ~--'43.7 ~ / ...... ~ / ~,T~
10~° ~ ~
~'~4(~/4 : :o, :-, o ,; ,o:, ', :19~~ ~[~-~2
~S~ WA~R AND WAS~WA~ CONS~TA~S, ~C.
WLU rUE SU~mWS~O~ ~2, LOT 7,, aLOCK 2 49
r"r~.._... ~F T~IIII T ....
AS-BUILT OF SEPTIC SYSTEM UPGRADE (I.S.F.)
PREPARED FOR: PHONE NUMBER:
KAREN REY 346-2711/264-20~5 ~'%.. C.E. ,.." .~
,,/~o/,, I J'L'M'/A'C'G' 1 = 40' 2 OF 2
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B - Anchorage ~ Alaska 99504
Phone (907) 337-6179 - Fax (907) 338-3246
Consulting Engineers
November 17, 1998
Municipality of Anchorage
Department of Heelth & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Atto: Jim Cross & Dan Roth
Reft ISF Installation at Lot 7A, Bk 2, Valli Vue #2 S/D. Sand Filter Material.
Dear Mr. Cross and Roth:
Attached are copies of two (2) sieve analysis that wore performed on the sand used for the subject
ISF. The materials were purchased by Wood & Sons Excavating from Q~mli~ Sand & Gravel
(John Watters, 1-800-478-5213). It can be seen that the percentage passing the #100 sieve
varies from 1.6% to 3.0%. The percentage passing the #200 sieve 0.9% to 1.8%. The MOA
specifications require less than 2% passing the #100 and less than 1% passing the #200. In short,
the sand provided by QS&G, although close, does not meet the MOA specification. Based upon
my conversations with QS&G and Central Paving Products (Sam Giamalva, 563-3654) neither
plant produces a product that will consistently meet the MOA spec. John Waters said it would be
possible only if the material is washed, and that he wouldn't have his indoor washplant operational
for several months.
I contacted Orenco System, Inc. (11/18/98), the developers of the ISF packages approved by the
MOA, and talked to Eric Ball (1-800-348-9843). He indicated that the State of Oregon requires
less than 4% passing the #100 sieve for ISF sand material, but indicated Orenco would prefer 0-2
percent passing the #100 and 0% to 1% passing the #200. He stated that the percentage of fines
in the aforementioned samples (3% passing the #100) should not materially diminish the
performance of the ISF. Based upon Mr. Bali's comments, and the subsequent verbal approval
of Dan Roth, the excavator utilized the sand provided by Quality Sand & Gravel.
It is our intent to use the same material for the ISF installation currently underway at Seatum, Lot
9, Bk 2. After this installation we are going to postpone the installation of any additional ISF
systems until the quality control issue is resolved to your departments satisfaction.
If you have any questions, please contact me at 337-6179. Thank you for your assistance in this
n~ttor.
Jeffrey//~ G~
President
'pt~ ~ ~ ~ EVgPECTION REPORT
MUNICIPALITY OF ANCHOP~AGE .2 BUILDING SAFETy DMSION
3500 EAST TUDOR ROAD, ANCttORAGE, ALASI~
INSPECTIONS: Voice: (907)563-3464
Fax: 007) 343-3235 INFORMATION: (907) 343-8211
PtlONE #1:
DATE: 07:32 AM
PHONE
LOT:. ~L T t~' BLOCK:
TYPE OF
INSPECTION ~ c ,.' e~,~'
.,~. No non-oofi~p~qnc~ obserwd.
~ W~ ~i~ ~ n~ ~fion.
CO~:
#2: #3: Tkie ls a re.
tnspeet(fl, ox []
L/ff' f: 7 ~/ ,)/ ~ /~1 is ehecke~
[] Cormofions essential as exphinedbelow. ;' ~] C.O. approved.
[~ Donot0onc~ahmfilre-inspected. [J C.C.O. appio-¢~i(aommentsbelow).
STARTTIME:
STOP TIME:
INSPECTOR:
WHEN COI~9,ECTION$ ARE M[ADE, PLEASE CALL FOR INSPECTION
DO NOT REMOVE THIS NOTICE.
Anchorage
G~vel M,A, Work ~heet ., .~,.~.'
&
:'~
RECEIVED
DEC ~ 199g
Municipality of Ancr~omg, e
Oept, Health & Human Services
,~DOWL ENGINEERS ~ AASHTOACCREDITEDcONSTRUCrION
'z.-~ALAS KA TESTLAB ~r~,m~s ~s==~
LABORATORY
FACSIMILE TRANSMITTAL FORM
Work Order Number: A28172
Date: November 18, 1998
TO:
JeffGaraess
A1~sk~ Water & Wastewa~er
Anchor~e, Al~ka
FAX#:
338-3246
SUB3ECT:
Ondafion Test Result- Re), Sand Filter Project
FROM~
3ess Burton
If this transmission is incomplete,
please call (907) 5§2-2000
Alaska Te~.lab
Out fax number is (907) 563-3953.
Om' machine is an automatic Xerox
Model 3010.
Original is being sent by mai]. ~'~ Yes
~ No
Number of pag~ including this cover sheet: 2
4040 "B" Strut · Anchorage · Alaska · 99~05-5999 * 907~562-2000 · FAX 90'A563-3953
e~aJOUgtl~/),0 f4!led!a!unl~l
0
o 0
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
PO. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 12, 1998
Expiration Date: Oct 12, 1999
Permit Number: SW980404
Legal Description: VALLI VUE ESTATES #2 BLK 2 LT 7A
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Karen Rey
Owner Address: 10610 Lone Tree Drive
Anchorage, AK 99516-
Parcel ID: 015-322-63
Site Address: 010610 LONE TREE DR
Lot Size: 21850 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
5. The following special provisions.
THIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN iNTERMITTENT DOSING SAND FILTER
WASTEWATER DISPOSAL SYSTEM. THE ATTACHED PROPERTY OWNER MAINTENANCE AGREEMENT
SHALL BECOME A PART OF THIS PERMIT PACKAGE.
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
$25 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
http://www.ci.anchorage.ak.us
December 3, 1998
Jeff Garness, P.e.
Alaska Water & Wastewater Consultants, Inc.
7320 East Chester Heights Circle
Anchorage, Alaska 99504
Subject:
Waiver Request for Lot 7A block 2 Valli Vue Estates #2
Waiver Request #WR980066
Parcel ED #015 322 63
SW980404
Dear Mr. Garness:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
2.0 feet. This approval is for the absorption field to the NE property line
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
Waiver
WR~/~\~,q~f~6n PID# 015-322-63
Date Received: Sept 24, 1998
Legal Description: Lot 7A block 2 Vall~ Vue Estates #2
Engineer:
Applicant:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Review Worksheet
HA9 Permit
Jeff Garness, P.E., Alaska Water & Wastewater Consultants~ Inc.
7230 East Chester Heights Circle, Anchorage, Alaska
Karen Rey
Waiver Requested:
99504
2 foot lot line waiver to the northeast lot line
Criteria: Points:
1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
SPecial Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~g ~/.,~/~f~ I/
Date: /~ '/Z--¢~ By, p~W
Name of Reviewer
Rec #: 04078/5580 g_mount: $ 115.00 Date Paid: Sept 24, 1998
Alaska Water & Wastewater Consultants, Inc.
7320 East Chester Heights Circle ~ Anchorage - Alaska 99504
(907) 337-6179 - Fax (907) 338-3246
Consulting Engineers
September 23, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Sewer Upgrade for Lot 7A, Block 2, Valli Vue Subdivision
To whom it may concern:
The existing 4 bedroom house is served by an onsite septio system, and a private well. The
existing trench is surcharged and must be upgraded. Comments regarding the proposed upgrade
are summarized as follows:
1. GENERAL: There are a number of site restrictions which limit the available spots to put the
new drainfield, These restrictions are summarized as follows:
· The setbacks from the existing system.
· The presence of poor soils on the southwest side of the lot.
The location of the house.
The location of the water line.
Cdven these restrictions, there is limited space on the lot to put the new dralnfield (a conventional
bed); therefore, we are proposing to install a bottomless, Intermittent Sand Filter (ISF). We also
request you issue a 2 foot lot line waiver to the northeast lot line. Our client has requested this in
order to save some trees that are to the northwest of test hole #2.
2. SOILS: On September 16, 1998, two test holes were excavated and percolation tests
performed. We are proposing to use the area around test hole #2 for the dralnfield site. The soils
in test hole #1 was found to be unsuitable for an on-site septic system. As can be seen from the
attached log for test hole #2, the soil below the organic layer is a SM material with SW lenses to a
depth 8.0 feet and then the soils transition to a primarily ML layer with SM lenses to a depth of
16 feet (bottom of test hole). No ground water was encountered at the time of excavation. Two
percolation tests were performed at 3.5-4.0 feet and at 5.0-5.5 feet. The percolation rate was 8.6
and 2.7 minute/inch.
TRENCH DESIGN: Bottomless Intermittent Sand Filter (ISF)
a. Percolation Rate: 8.6 & 2.7 minutes/inch
b. Allowable Application Rate for ISF: 2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600, gallons per day
e. Minimum Absorption Area: 300 ft2
f. Effective Depth below pressure pipes: 3+ inches
g. Width: 10 feet
h. Length: 36 feet.
i. Effective absorption area = 3601~2 (>300 R2 OK)
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: Central Paving Products "Winter Road Sand"
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 4 feet (maximum), place a minimum of 6 inches
of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will
place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a
conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can
be intermittently dosed to the tSF.
4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
5. TOPOGRAPHY: As can be seen on the attached topography site plan, the lot runs from
approximately southeast to northwest at a grade of 5-10 percent. In short, there are no slope
concerns.
6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation &
Maintenance Manual". The contractor should read this document prior to construction. Copies
are available at the Municipal Onsite Services office (Sth floor, 9th & L St.).
7. CLOSING: Cdven the site restriction, I think the ISF is the .most viable option for this lot,
short of install a Recirculating Upflow Filter, which would be more expensive. I am open to any
suggestions from your department, which would be an improvement to the proposed design. I am
unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact mo at 337-6179, or 244-9612. Thank you for your
~ssistanee.
TOBBEN
LOT 9, BLOC}< 2
VALLI VUE S/D
EX~STING
SYBFEM
4 BEDROOM
HO[JSE
NOTE: AL[. SURROUNDING PROPERTIES 1
SHOWN ARE SERVED BY PRIVA'FE SEWER
A COMMUNIIY WATER SYSTEM.
ALASKA WATER AND WASTEWATE~ CONSULTANTS, INC.
75~0 E. CHemfe_R HEIGHTS CIRCLE, ANCHORAGE, AK gg504
PHONE: (907) 3~7-617B/FAX: (gO7) 338-3246
LEGAL DESCRiPtiON:
VALLI VUE SUBDIVISION, LOT 7A, BLOCK 2
TYpE OF WORK:
SITE PLAN
PREPARED FOR: PHONE NUMBER:
KAREN REY 346-2711/264-2015
DATE: BY: SCALE:
9/23/98 J.L.M./A.C.G. 1 = 100' 1 OF
P.
'.. NO, 9608
~ 1.25 INCFI HDPE LINE SLOPED BACK TO / ~ INTERMI'SFANT
UFF STATION FOR DRAINAflE OF LINE. NO --PROPOSED BO~IOMLESS
COLLECT. ALL CONNEC~ONS SHALL BE DEEP(~IMUM) BY 10
~070, AS SUPPLiE9 ~Y ANCHDRAGE T~K, TH~ AIR LINE ~ SEIVE ANALYSIS FROM THE DISTRIBUTOR OR HAVE
~EPTH OF 3 FEET. . ~ 2. THE CONTRACTOR SHALL HAVE THE NORTH~T
THE CONTROL P~EL FOR THE STgP TANK SHALL ,~~ ~ ~ PROPER~ L(NE F~GGEO BY A REGISTERED ~N~
AND WAS WA CONS TA S,
VALLI VUE SUBDIVISION, LOT 7A, BLOCK 2
DESIGN OF SEPTIC SYSTEM UPGRADE
PREPAREO FOR: PHONE NUMBER:
DATE:9_23_98 1 = 40' 2 OF
', ' , r~AJI~LIN~.COJLCA¢CP^I' ~/4" PlA 5CH
PLAH V~EW
~/4" PVC
/ /
~¢ / ~¢ / / O~Ad~b
~S~ WA~ ~ WAS~WA~ CONS~TA~S, ~C.
~3~o ~. cH~ .~H~ a~C~. mC.O~.
VALLI VUE SUBBIVlSlON, LOT 7A, BLOOK 2
BOTTOMLESS SAND FILTER (ISF) DETAIL
PREPARED FOR; PHONE NUMBER:
~/~-~o~s~.'-.. ~... ..-'.~
KAREN
REY
346-271
J.L.M. N.T.S. 3 OF
7320 E. CHEER H~. CIRC~ * ANCHORAGE, AK. 99504 ~v
I SO,L LOG - PERCOLATION TEST] ff~}~g~~- ~ '"~
DATE PERFORMED: 9/16/98
I r~sr ~o~ ~ ~ ~a~r.~ .......... ~,~
'~r o f ess~oO
DEPTH ~
~lJ[J]J2ljIll ~o.~ c~ss,.,C~T,ONS .~ / ~ x ,, ~x ,
GW ~: ORG
DENSE OOMPACT SIL~ ~¢.
i SH OH
SC
DEPTH TO DATE
GROUNDWATER ....
[ SITE P~
10 ¢~( ~l~ ~, I" = lO0' ~ 'q~ d
11 ~ DATE READING CLOCK NET TINE WATER LEVEL NET DROP
TIHE (HINUTES) RE.lNG (INCHES)
g/~8/~ _ [ ~:.o ..... s !/2"
3 5:40 30 8" 1/4"
RE~SAL AT ~RGE
BOULDER
PERCO~TION ~TE 120 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20
TEST RUN BETWEEN 5.0 ~. AND 5.5 FT.
co..Ts:
PERFOMED BY A~SKA WATER ~ WAST~ATER I, , CERTI~ THAT
THiS WAS PERFORU~ IN ACCORDANCE W~TH ALL ST~T ~d MUN~C~m[ aU~DEUNES ~N EFFECT ON TH~S
DATE. DATE:
DEPTH TO DATE
GROUNDWATER
DF~ 9/4 6/9~_
'A!,&SKA WATER & WASTEWATER CONSULTANTS, INC.
7320 E. CHES~R HTS. CIRC~ * ANCHO~GE, AK. g9504 ~..
{SOIL LOG - PERCO~TION TEST]
,..: ........ ~_~7t.~ ~.~: ....
LEGAL DESCRIPTION: VALLI VUE SUBDIVISION, LOT 7A, BLOCK 2
PERFORMED FOR: KAREN R~ ' ~JAMES'~."~iLLJA'~]~
DATE PERFORMED: ~/16/98
~,".... c.E...'".:~
{TEST HOLE ~2]
DEPTH r ......
1 ~ O~G PAGE I OF 2
~ sw ~ oR~
6 ~ SC
7~%%%'~ ~ DEPTH T0 DATE
GROUNDWATER
8 D~ 9/16/98
10 I i - ~uu J
W/ SM LENSES DATE RE.lNG CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
gl16/9~ . ! .... 4:41 6"
1~ __ ~ ..... 5:12 ~" _
15~ ...... ~ __ 6:1[ 3g 2 ?/2" 3 1/2"
B.O.~
PERCO~TION ~TE 8.6 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20~ TEST RUN BETWEEN 3.5 FT. AND 4.0 FT,
, co,,,~s=. ,~,c. ~¢~ ~. ~,~ .~..o.....; ,,,c, ,Vc. ~o~, o,~
~ERFOMED BY A~SKA WATER ~ WAST~ATER J, ~A~ ~ , OERTI~ THAT
THIS WAS PERFORMEp I~ ACCORDANCE WITH ALL ~'AT~'~ND '~UNICIPAL GUIDELINES IN EFFECT ON THIS
DATE. DATE: ~.~ ~
DEPTH TO DATE
GROUNDWATER
D~Y _ ~9Z16!9~ _
_ .~ .... ~ l~j,~
ALAsIc~ WATER & WASTEWATER CONSULTANTS, INC. ~.~-'~'~?"~,~.~.
7320 E. CHES'II~R HTS, CIRCLE * ANCHORAGE, AK, 99504
,,o.E (907) ~37-5,79 · rAN {907) ~39-3245 ,t %.~" 9 .,.t-."~.~O~
LEGAL DESGRIPTION: VALLI VUE, LOT 7A, BLOOK 2 .~. ....
(f~et)ITEST HOLE ~21 -
2~ SOIL C~SSIFICATIONS
3-- ~ GP HL
GM CL
~ ~ GC OL
~ o.o~ SW MH
s- ~ sP CH
~SM OH SEE PAGE 1 OF 2
6~ SC
7-- ~ DEPTH TO DATE
~ GROUNDWATER
8~ 0 SEE PAGE 1 OF 2
10~
11 ~ ~ DATE READING CLOCK NET TIME WATER LEVEL NET DROP
~ TIME (MINUTES) RE.lNG (INCHES)
2 5:2~ 10 2" 4"
13 -- 3 5:23 6"
14-- ' 5 5:33 6"
6 5:43 10 2 1/4" 3
7 5:43 6"
16-- 8 5:53 10 2 1/4"
9 5:53 6"
19-- PERCO~TION ~TE 2.7 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20- ~ TEST RUN BETWEEN 5.0 FT. AND 5.5 FT.
COHHENTS: PERC. DATA ON THIS PAGE FOR LOWEI BENCH ~RC. HOLE ONLY.
THIS WAS PERFORME~ IN ACCORDANCE WITH ALL ~ATE AND MuNIglPAL GUIDELINES IN EFFECT ON THIS
DATE. DATE:
V
DEPTH TO
GROUNDWATER DATE
SEE PAGE 1 OF 2
~p_.S.E~P !_~_ '~. _l~j ~iPM REMAX PROPF-RT~ES~URKI.i~ ~?~o l~ P. 9 P, 8~
LOG -. PERCO~TION TEST
2
3
4
6
7-
~ownship:.Ra~ee, 8e?~dO~:'
?
/
11
12~
~4'
~C~JORDANOIWI?H^Li. OTA,gANDMUNJCIpAL~LJJn~LiN~iNEF~$CTONTHi~DA~, OAT~: ~__~..~1/~,~_. ~
,, ~ ,,
L E(3A L DE,~CI~I~ ,'¢iQN:~ ~
11-
12,-
1'; ,
COMMENT~ .
,~0~ E I)lTa PI.AN
I
'~RO~ : ~L~$KR ~RZER & ~R$]'E~RTER ,PHONE NO, : 90?3383246. Sep, 28 t99B 0B:32flM P2
PROPERTY OWNER AGREEMENT
FOR THE MAINTENANCE OF AN
ON-SiTE WASTEWAT~-R DISPOSAL
SYSTElVI
~ a~ecm~, da~-d 199 _, is.made he,vein ~he Municipality of
Anchorage Dep~,u~¢nt of Heal~ and Human Services.(DHHS) and ~be prol~'ty ..
This a~cement is made for the purpose of maintaining an on-site wastewamr disposal
sys,em, ou ~e subject prope~y. R F C [ ! V E D
The property owners agree to ~e ~ol/owing: OCT 1
Municipality of Anchorage
Dept. Health & Human Sen/Ices
Submit m ~ Municipal~ of Anchorage, on an ~-.ual basis, an inspection and
op~ra~on smmme,~ from a rcgistcr~ professio~ engineer. This inspec~on and
operation statement sba/1 verify ~at flae engineer.has im'peete~ all effiuen! and
pumps, ~mer~, a~ alarms, and that any deficiencies have been repaked an~ that the
system is fuacfio~ag as desig~a~.
(Prin~ N~m¢) (Primc~
................ ' ...... Notarize Rede ..
.....
~o me ~ OFFICIAL SEAL
' ' e basis o~ ~ IATEOFALASKA
My covission expires ~]~[
ed 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
MAILING ADDRESS
~1, Absorption area Dwell,~ , PERMIT NO.
~ ~ Eiq. capacity in galJons ~ Inside length Width Liquid depth
~O~ IF HOME.DE:
O Z ~ Manufacturer ~ M ~pacity in gallons~
D Well t ~Foundation ~ Nearest lot line PERMITNO,
.~ Type of crib ~ ~tive absorption area
~ ~ ~ Crib diameter ·
m ~ ~ Building foundation Nearest Iot~ ,
OTHER
72-013 (Rev. 3/78)
F'EF~:I"I)J T
FI F:'I'::' L. ]: C:PIN'F
LOC:FIT I OF,!
LI:E ('JiF1[..
L. ONETF:'.EE DR
1.7' B2 ',,,'FiLL. i ',,,'LI[!(
;~!:58E'~ I,.Y'¢OI',IFI L..FIi',!E
LOT
2E~850 E;(;RJ!Ulf;i:[:'.: t':'E[E]"
T'¢I::'E OF' SOIL. FIBSORB'F!OF,I S'T'S'i"!-~M IS: -['F.'.Ei",IC:I-I
P1FIX.[P'IUP1 iqUi','lES:;: OF' E:EI:,F~:OOHS =: :i!:
'J/:;OIL. [~:f:t]'IN61 ,:;S6! FT,-."E:R):::,
THE F?.Eg!LO:RED SIZE OF THE SErZL FIBSORPT:[OI',I S'¥'STEM IS:
'THE LENGTH D I i"IEN_'.~; I Of.,', i S "n-.IE LEIqGTI--I ( I hi FEE'[' ) (]F' THE 'I'I;;:ENC:H OF'. DF:I::II NFI E!..D.
THE DICP-I"H OF' I:'~ TREI'.,ICH Of4: Pi'f' IS TI..!I::"-: D:[S'i'F:INOE E:E'f'I,]E:Edq THE SUF[:FF:IOE OF' THE
GI-;;:OI._If.,ID I:::IND THE Etl)TTOi'q (]iF 'Fl-lEE E',:.:',C:FI',,,'F:ITZON (Ii'.,I FEET).
THEFd:!! :I:S I",10 'SET I,.lII]:,q"l-..l FOF:
'FI-..I[E C. iF~:F:I',/E'L DEFq"H Z~:!; THE f'IINIMLIf,'t D[_::P-I'I-.-I OF GF?.I::I',,,'EL. E!:DJ'I"I.,.II:-::[Ei'.,!
F!ND THE [.::O'['TOl'q !)F THE E,'.'.:',C:FIV'FITICIN ,::]:['.,I F::[EF'T).
F:'ERr,1 :t: T FIF'F'L I CF:INT F.11:::I'S THE RESPONS I E,' I L. I T'./ -I"0 I NFORr,1 TH Z S; IDEF'FIF;rT PI[:_'I',IT DIjI:;~: I lq6i
I NSTF:ILL.FIT ~ Oi'.,l I NSPEC:"I" IONS OF FtN"r' !4EL. Lg_; FIDJFIE:IL::I",!T TO 'I'H Z :L:; F'ROF'ERT"r' FIt",!£:, THE
i"~I...IHBER OF:' F;:E's:r. DENOEE.; THF:IT THE HELL IqILL SEF~VE.
'rile
lii~F~CKFILJ._.ING OF I-alq'¢ S'./STEi',I H]:THOLrf' FII',IFiL INSf:'ECTION FIND
D[EF:'FiF;VFi'q[(NT !.qIL!... r.-'.':t~E SUE:JECT TO F'F~:CISECI..I-I"IEII'.,I.
FIF'PF?.O',/FIL B'./ THIS
Pi.[N]:I'"ILIP1 [:,ISTF!I'.~CE BETI.,.I[::Ei',! R t.4EL. L. i::li",l[) Fliq'¥' OIq-SZTE SEklFISE E:,ISF'OSF:IL Str'."-];TI:.:.'M
J..',.})E~ F[(ETf' FOF,;'. FI I::'F:I'v'I::I-!"E 1.4EI...!...; 01';~:
::LSE~ TO 28E~ FEET FF::OM I::I F'UE~I...XC HELL DEF'[}:NDING LIF'ON THE T"r'PE OF PU[SI..IC 1.4EL. L..
OTHE[;?. F;%6!LIJ:E:L:EP1EN-I"S !'"IF:I%' Fff:'F:'I-V. SF'ECZF!CRTZOi'4S FIND CONS'f'F?.UIE:'FZOI'~, [)!F:IGF~:FIf'I'J];
FI',,,'RILFIEIL.I:E TO ]:NS;LIF;?.E F:'F?.CIF'EF;~: II",I'J?ITiL.LI::ITIOI',I.
F'OF?,TI'I E~"r' THE FII...INZC:IPFILZT'¢ OF' FII",ICHL")F?.FIGE.
2: I t.,.I]:I...L. INSTRL..L 'THE: :'5"r'STEP1 :[i'q FIC:COF:DF:INC:E HITH THIE CQD[:::S.
F
LOT SURVEY CERTIFICATION:
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY SHOWN AND DESCRIBED HEREON AND
THAT THE IMPROVEMENTS SITUATED THEREON
ARE WITHIN THE PROPERTY LINES AND NO
ENCROACHMENTS EXIST,
Prepared by: GERALD V. RANDALL, JR. Reg. Land Surveyor
1135 WEST 8TH AVE., SUITE 5
Phone: 279-7414
ANCHORAGE, ALASKA 99503
IT IS THE CONTRACTOR'S RESPONSIBILITY
TO CHECK TOP OF FOUNDATION IN RELA-
TION TO FINISH GRADE AND BUILDING
SET BACKS IN RELATION TO LOT LINES
AND EASEMENTS.
LEGAl_. DESCRIPTION:
V~., : i i,ol /
'~ i..L.I './i.iizI' ::-'i ~';".:.
LEGEND:
· 5/8 REBAR RECOVERED
o 5/8 RESAR SET THIS
SURVEY
[3 2'~2" HUB & TACK SET
[~ EXISTING ELEVATIONS
DATUM ASSUMED
SCALE: ./' _ i
4-
5-
6-
7-
8-
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /[]g PERCOLATION
TEST
Pouch 6-650, Anchorage, Alaska 99502 276-222~/
SOILS LOG - PERCOLATION TEST
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
i~.'~ ,so ,-,.~, I! ~ ~ "
/~.'/0 ~ .~. II ~ ~ ~'
PERFORMED BY: /? CERTIFIED BY:
72 008 (7/76)
PERCOLATION RATE (minutes/i~ch~
TEST RUN BETWEEN ~ , FT AND /~"? FT
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. Cf 01 5-322-63'~i
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA
Lot 7A; Block 2; Valii Vue Estates #2
Location (site address or directions) 10610 Lone Tree Drive
. Anchorage, AK
Property owner
Mailing address
Lending agency
Mailin_g address
Agent
Address
Karen Rey Day phone
10610 Lone Tree Drive Anchorage, AK 99516
Day phone
346-2711
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well ××
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA~21
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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 9,f~his inspection.
Name of Frm Au~41~,__ UJ~¥¢~.~.~.. ' 6V~s/'~-~,,,~J~:~'~u ~-'¢~-~1/::)~n¢ ', o e. ~'? 7~(~/7~'
Engineer's signature ~, ~r~ ~"~"~ Date ,z ~
ALASKA WATER & WASTEWATER CONSULTANTS INC
IS TO BE PAID$1300.00 AT CLOSING FOR'
ENGINEERING SERVICES PERFORMED.
DHH$ SIGNATURE
_ ~, Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 D HHS does this as a courtesy to purchasars 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.
RECEIVED
Municipality of Anchorage DEC 03 1998
DEPARTMENT OF HEALTH & HUMAN SERVICES
MUNICIPALITY OF ANCHORAG
Environmental Services Division ENVIRONM[NTAI.$E~.Vi~E$ DIVI..S,
825 L Street,.Room 502 · Anchorage, Alaska 99501 · (907) 343-47q4
Health Authority Approval Checklist
Legal Description: bo'~ -7~,) ~7_~. V,~cu~ ~/~,F-- ,,'l:t'~. Parcel I.D.i
A. WELL DATA
Well type Co~t~l {~B, or C, attach ADEC letter. ADEC water system number
L~.Y/N) Cased~te con"~leted Casing height (above ground) ~
Sanitary seal (y/NT°tal depth "~~ Wires properly protect. C'(~/N)
Date of test __
WATER SAMPLE RESUL~
Coliform ~ Nitrate
I;~-a't~ sam pie:
B. SEPTIC/HOLDING TANK DATA
Date installed ///?'~
Collected by:
Foundation cleanout (Y/N)
Date of Pumping I~
Other ba~....
Tank size /.~-00 Number of Compartments__'7-- Cleanouts (Y/N).'¥'
Depression (Y/N) 'Y' '~ High water alarm (Y/N) ¥
Pumper
C. ABSORPTION FIELD DATA
Date installed
Length 25 (~ Width
Effective absorption area -~
Dat~acy test Results (Pass/Fail) : For ~D~ms
Fluid depth~~dded (in.):
_.~_Perox' ment (past 12 months) (Y/N) If yes, give a e ~..
72-026 (Rev. 3/96)* .-~
D,
LIFT STATION
Date installed il/'78
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested /'J./~
Size in gallons /,~
"Pump on" level at* -T-//,-,~'2-- "Pump off" level at*
*Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: ~'J/~
Septic/holily. . On adjacent lots
Absorption field on lot ~~' ~
Public sewer main --~ / Public sewer manho~
Se_,~ue,~se~ ~c'ti'~ervice line Lift station
SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOT TO:
Foundation 5/4- Property line ~'/'+- Absorption field
Water main/service line / 0/v- Surface wateddrainage / O0/'~ Wells on adjacent lets .~Do ''+'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/ ~f Water main/service line
Prope~y line ~' '~ Building foundation ./0/'~ /0 ~''~
Surface water /00 '~ Driveway, parking/vehicle storage area /0/'f-
Curtain drain ~Jo,~.~- ~,~ouo,,,)A Wells on adjacent lots
//
ENGINEER'S CERTIFICATION ~ / '
I certify that l h/av~e~r~ e~u #l d inspections and review of Municipal reco~
in conformar~ce with MC2~ '~A~ui~ ?nes in effect on this date.
Signatur/ .~/~/~ ~'~" '~-"-"-~ _
Engineer ,~ Name ~'
Date / z.,/i/~'~
NAA Fee $.
Date of Payment /~:'~//;~ /if
ReceiptNumb/7(~'~,~z~',,~ ~) Z//~_~ ,~ ~-'~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lo ~ 7., B~oc~ ~., t/,~t(; u',~e ~,.r-~
Location (address or directions)
(b) Property owner "T
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent /~"o ~'/'~,~- f~f-o/~er ~'.e~-
Address ~0~ ~" ~ j ~ 6 ~o~ ~
Telephone ~8- 7¢~
Telephone: (home) ~%/- ~'~' Business ~'¥-
Telephbne .~-ffq -o
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community I~' Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
~ J.o ~ e6ed
'~JO/~ 9,Jeeu!bu@ leUO!SSe~oJd eq~ u!
suo!ss! u JO JO s JO J Jo JOj elq !suodseJ ~ou s! @~8Joqouv jo/~.!l~d!o] u n ~ eqJ. 'penss! si e~eo!J!~Jeo e eJojeq ~ep @Z,~leUe JO
suo!~o@dsu! tonpuoo tou op SHHQ jo see,~oldtu3 's~UeLU@J!nbeJ e~s pug leJepe,~ u!e~Jeo,~JsRgs ol JepJo u! suo!~.n~Bsu!
bu!puel J!etR. pus sewoq ~o sJ@seqoJnd o~ ,~selJnoo ~ se s!q~ seop SHHQ eq.L 'e~lselV Jo et~3 eq~ u!
Jeau!bu@ leUO!SSejoJd ~u@puedapu! ue ,~q e^oq8 ~ qdeJl~ed u! ue^!6 suoBe~ueseJdeJ eq~ uodn ,~lUO peseq
le^oJddv A~!Joq~nv q~leeH senss! (SHHC]) seo!^J@S uswnH pue qlleeH j.o ~,ue~u~J~dac] eS~Joqou¥ jo A~!l~d!o!un~ eq.L
le^oJdd¥ 19uoB!puoo ~o 9uJJe/
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
o~ A~C~OT. A68-43-4744
~ ' ? ' Lega~ Description:
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary SeaJ on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed .~'/.~/79 Size /OoO ~
Standpipes (Y/N) ~' Air-tight Caps (Y/N)
Depression over Tank (Y/N) I~
Pumping/Maintenance Contact on File (Y/N) /~, ,4-.
Holding Tank High-Water Alarm (Y/N) /~h ~-,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
No. of Compartments ~
Foundation Cleanout (Y/N)'~ (V
Date Last Pumped (I/l(/~'~ /~, /"'~' ~co,zc-r-
; for hI,/,~,
Temporary Holding Tank Permit (Y/N) /~h/4.
To Building Foundation
To Disposal Field d' r
To Water-Supply Well ~
To Property Line ~. fo '
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ~' T_~,n ~ h.r C
"~ (00 t
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~ ~ C' ¢ ~ /~,(f'ro Type of System Design
Date Installed ~'"/.~'/ 77 Length of Field -7,5- '
Width of Field '8, .~-'
Square Feet of Absortion Area
Depression over Field (Y/N)
Depth of Field I Z
Gravel Bed Thickness '¢ '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test I'~¢c~/~xr'e¢ ,rc,.6_cor/~Ao.~ r'a ~ of ~17/~1/~ ~ ~¢¢~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well _ >. 8oo ' To Property Line lc '
To Building Foundation 13 To Existing or Abandoned System on
Lot ~f, 4, ; On Adjoining Lots ~ ~o '
To Water Main/Service Line > ~--~' '
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutback (if present)
~ fcc '
D. LIFT STI~.TION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date
MOA No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
TH ~. .~ ~ .
~ W ~ 4¢~ ~ ~ % W CEngmeer's Seal
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
DATE: 11/1/89
PWSID: 210605
Requested By: Flattop Technical Services
According to the records on file in this office, the
Vue S/D Water System is in compliance
State of Alaska Drinking Water Regulations.
~alli
with the
Sincerely,
Cindy Thomas
Environmental Engineer
INVOICE
SEWERAND DRAIN
'"~"~ ¢~ '~'~ CLEANING SERVICE
RO, BOX 112688 PHONE 348-2513
Job Address
ROTC-ROOTER SERVICE CALL
STEAM THAWING
TRIPCHARGE
OVERTIME CHARGE
ADDITIONAL LABOR CHARGE
ANCHORAG E, ALASKA 99511-2688
HRS.
HRS.
HRS, @
HRS, @
(~"P~UMPINGSERVICE~d) (GAL.) HRS. @
HYDRO.J ET SERVICE HRS.
~ MATERALS,-~ ~ ///~ ~/ ~/, ~
. ; . ,_
~LEAS~ PAY FROB TH~S INVOlO~ TOTAL
TOTAL FOOTAGE CLEAN ED OR THAWED BLADES USED
PRO~BASLECAUSEOFSTOPPAGE..--,r, -,-:/ ~. r ~.; // //~'~/~
LINE C{.~AN~D
[] JOB NOT GUARANTEED FOR FOLLOWING REASON
WORK ACCEPTED BY.
APPLI( ']NT FILLS OUT UPPER HA': ' ONLY
Address
Type of Resi~nce
~ngle Family
Water Supply
~di~idual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wefts drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer isposal
~ividual Year Individual Installed;
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOT~: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OC~SSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
RECEIVED
( ) CONDITIONAL APPROVAL'
DATE ~ ~ '//- ~' ~'
'~'-~'~ ~-~) '~- ~ ~ 7 ? Well ,o Tank Septic Tank Size
72.023 (3/~)
~ DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
/VJUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF I'.::ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI~/~I~MENT/\L ~ F, DYECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION FEB 2 5 1980
- Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~E&~ flyL~/'~ES
;)IRECTIONS: Complete all parts on page 1. Incomplete requests will ~ot be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
MAILING ADDRESS /
PROPERTY RESIDENT (If different from above) J I PHONE
2. BUYER PHONE
MAILING ADDRESS , ,
3. L~~O~ / X~r~"~I- d~ ~' PHONE
MAILING ADDRESS ~_///~ ~/ ~'
4. REALTOR/AGENT ~'~ PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
;TREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four , [] Other__
,~ [] Two [] Five
SINGLE
FAMILY
[] MULTIPLE FAMILY [~ Three [] Six
7. WATER SUPPLY
[] 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
,,~ INDIVIDUAL/ON-SITE** /¢~.~' YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SiX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER (~.
[]Septic Tank or/,') []Holding Tank _.,~_..)/(.~.~,._../ ~../~..,, ,.
Size: ~)_.Lb If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER/'~'
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCESwELLT0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[~/APPROVED FOR ..~) BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
/
/
72-0t0 (Rev. 6/79)
20,2~9
1
8
20, 169
2z:85
47
20, ]38
5
27',376
N. 89° 5~_Lw_ ........ EDGEME~' SURVEYOR'S CERTIF_ICA~TE
--~ RY'S Ac~WL I ff~e undersigned
NOTAR~ a ~ ~ ~ -~ k'~ebv cerhfY that a lanu ~,~
subscrib~ and sworn to before nth~s ~'en'Completed byme or
., ~doy of-* :~_~ 1971 direct supervision and that
nd monuments hove been I9cc
~u~u¢~¢ ~stoblished and that the
~," ~/% shown hereon ore true ondcorj