HomeMy WebLinkAboutVALHALLA BLK 3 LT 11b+ .1/.
LoT'
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP23,1269
Work Type: Septic Upgrade
Tax Code Number: 01521211000
Site Legal Address: VALHALLA BLK 3 LT 11 G:2736
Site Mailing Address: 12316 WILDERNESS RD, Anchorage
Owner: KEARNEY ALBERT P III & KAREN L
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date
��»int
�ot
�^
J.
De pertinent
Lot Size in Sq Ft
Total Bedrooms:
9/18/2023
9/17/2024
16000
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
40 Date:
Issued By: Date:
4
9.
Development Services Department `~' = Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-212-11
Property owner(s) ALBERT & KAREN KEARNEY Day phone _
Mailing address 12316 WILDERNESS ROAD, ANCHORAG, AK 99516
Site address 12316 WILDERNESS ROAD, ANCHORAG, AK 99516
Legal description (Sub'd., Block & Lot) VALHALL BLOCK 3, LOT 11
Legal description (Township, Range & Section)
Lot Size 16,000 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
El
Upgrade El
(D) El
Holding Tank
❑
Renewal ElDuplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
nature of property owner or authorized agent)
C
Permit/Rush Fees: � 9 T Waiver Fees:
Date of Payment: 405?_6 Date of Payment:
Receipt Number: I/ 716 ( Receipt Number:
Permit No. 0� L 3 1 Z b o Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
August 14, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: VALHALLA BLOCK 3, LOT 11
The 50-yearold septic system has been found failed and will be completely
abandoned and per code. The owner has requested we upgrade the existing septic
system on the above referenced lot. We propose to install a deep trench with an
Advantex system to serve the existing 3-bedroom residence per the attached design.
The system and reserve have been designed to accommodate 4 bedrooms. The
design is based on the recent test hole conducted in the summer of 2023. No
groundwater was observed at excavation or monitoring of this test hole.
The slopes are at 10-15% at the proposed upgrade location and no slopes greater
than 25% are present within 35’ of the proposed field. The lot and area are served
by private water with no known private wells within 50’ of the proposed septic
system. Based on visual observations and review of available information, the
design will not impact any of the neighboring properties. Please contact us if you
have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231269, Deb Wockenfuss, 09/18/23
FIRST WATER CONSULTING
VALHALLA BLOCK 3, LOT 11
DESIGN CALCS:
NO WELLS WITHIN
50' OF PROPOSED
SEPTIC SYSTEM.
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231269, Deb Wockenfuss, 09/18/23
FIRST WATER CONSULTING
DESIGN DETAILS:
VALHALLA BLOCK 3, LOT 11
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231269, Deb Wockenfuss, 09/18/23
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL : VALHALLA B3, L11
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 8/1/23
DEPTH
FEET OG
SOILS
1
2
ORG/OL
3
4
5
6
7
SM/gm
8
9
10
11
12
13
14
15
16
BOH
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net Drop
7/14/23 30 min 6 1 11/16
6 1 11/16
6 1 11/16
PERCOLATION RATE 18 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: NA - DRY
DATE: 7/14/23
TESTHOLE # 23-1 DATE PERFORMED: 6/29/23
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: ALBERT & KAREN KEARNEY
8/1/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231269, Deb Wockenfuss, 09/18/23
(D
CJ 00
Cn
LLI
Ln-
7-- (D
r�r) 0
0
P CD
0
0
z
00 0
194-0
66
00
WELL
3:
00
0
DO
CD �
O 0
z 0
0
z
N89053'45"E
159.29'
(N89°59'00"W
160-00' R)
cdESHEED
12.0'
TEST
HOLE
0
C5
00
SEPTIC
VEN T
(typ)
LOT 10
BLK 3
�24. O'��
N89"49'13"E Lj
N89*59'00"W 1 0
I
WELL
HOUSE W
<
LOT 11 1.2'x28'
BLK 3 CANT
GRAVEL
PARKING
57.7'
159.28'
160.00' R�
ft
0
(D
0
0
T_
3:
0
0
P
CD
0
z
0
in Z
VQ
w X 1,5'
4-1
(D
0
0 CD
0
22.5) GRAVEL
BRICK WALK D//W
1.5'x27.7'
(D
CANT 0
r4,)
P
0
0
z
30
N89"38'47"E 159-13'
(N89°59'00"W 160-00) R)
ANCHORAGE RECORDING DISTRICT, ALASKA I I
AS -BUILT OF:
VALHALLA SUBDIVISION FND 5/8" REBAR
LOT 10 & 11 BLOCK 3 PLAT P-644 SUR
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a ANW OF
�� �� it .a ; ... _ _..
AW, �"�
physical survey of this property as shown on this drawing and that tile0 Is,
A W_ <1
11P
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should #0 C') 49TH
any information on this drawing be used for construction of fences, ...... .......... .......... I
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine -10' ' . ' ' ' ' ' ' ' . ' .............
J N L. SCHULLER: '0
I N.
the existence of any easements, covenants, or restrictions which
LS -10408
do not appear on the recorded subdivision plat.
1831 Talkeetna Street
WORK ORDER NUMBER: DATE- SCALE;E—MAIL- Anchorage, Alaska 99508
JULY 24, 2023 1 =30 schuilerook-net
DRAWN BY, CHECKED BY: MD NUMBER: BOOKPAGE: 0 AW (907) 227-1455 office
23-075 1�1 'essionc
JLS SW2736 230230 (907) 274-4992 fax
MUNICIPALITY OF ANCIIORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into' as of this a/ Day of 5 ep7-e -� t e,% of 20��, by and betureen
/`
K6.aQ1,� , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as AN ADVANTEX SYSTEM
located at (legal description)
VALHALLA BLOCK 3, LOT 11
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
P It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
JOKK Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
X Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Pagel of 3
�P _ Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Ple Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
PAC Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
P Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement 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 Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: C Xis �f /"' �(eu��(signature) Date:
U
/0e;- T it 1/1 ex V,A4 (print name)
�7
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this fl�1 day of Pp�&6er ,
20d ,by f)tWr'f Pafir0 1�/Q
NOTARY PUBLIC
l � YIIJG LO
NOTARV P BLIC FOR ALASKA STATE OF ALASKA
MY COMMISSION EXPIRES May 1, 2024
My Commission expires: QYty r ,aor}4
MUNICIl'ALITT�Y/:
(/i/
By: (signature)
(print name)
Date: /� Z
Title:
(rev. 05/18/2018) Page 3 of 3
6 '1891 i
• � g rG��kie
B� Municipality of Anchorage �� - .a On-Site Water and Wastewater Program41, < mil 1a
(907) 343-7904 E JUL 1 8 as'1Y`l p
Certificate of On-Site Systems Approval _ <<1 c;\`
a & 9L. (1
Parcel I.D. 015-212-11 Expiration Date: I Q ` — 1 7
1. GENERAL INFORMATION
Complete legal description Valhalla Block 3 Lot 11
Location (site address) 12316 Wilderness Rd
Current Property owner(s) Robert & Roberta Snyder Day phone
Mailing address PO Box 187 Saint Helen, MI 48656
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well E Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
� /
Received b f�• -� 11 / * , Date: y/1" f ,7
COSA to be released to the engineer,unless otherwise requeste by he engineer.
COSA Fee $ 6Waiver Fee $
Date of Payment 'f161/0. Date of Payment
Receipt Number daqt5C1 Receipt Number
COSA# 61X191302. Waiver#
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, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 7/18/2017
6. DSD SIGNATURE
•"*____ ‘;
* � /1 * 9
4
I Id
•
System #1 Approved for 3 bedrooms 1. .Steve•R.'l annone. . ��
System #2 Approved for bedrooms c 4 , CE–B149 ���
Disapproved ���kk'" 'OFESSONt`� �
Conditional approval for bedrooms, with the following stipulations:
"" ' '' t S �c2 TIG `k'zt/vl IC 1 S 6-0 eG1,✓'S a 1
�u-di ( 1 7) c) Aie,euvc e '
rhn ( '1`X i CA.l,6 ,
' 23— 1 W`�—) 6.--(c" r,
—
I
tI
rn
ON-SITE i,G,
WATER AND r-'
WASTEVVATER a
1 PROGRAM U
' 1 .�
%?-,.,rte ,r.,:
r
By: Original Certificate Date: 7 — -17
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
l^'e{
7. ATTACHMENTS: C•...• s",. .;�.
COSA Checklist X Nitrate Advisory_
Septic System AdvisoryArsenic Advigby i "
Well Flow Advisory _ Other ^'-'Rt.4:+ n-,u,;-
COSA blue sheet j - ,.
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system '
Certificate of On-Site Systems Approval Checklist
Legal Description Valhalla Block 3 Lot 11 Parcel ID 015-212-11
A. WELL DATA
Well type Private If A. B, or C provide PWSID # Well Log (Y/N) N
Date completed UNK Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 115 ft. Cased to UNK ft Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test UNK 7/5/2017
Static water level UNK ft84.5 ft.
Well production UNK gpm 7.9 g p m
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 1 .30 mg/L
Arsenic NDug/L Date of sample. 6/1/2017 Collected by Garness
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 1967
Tank size 1200 gal Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N/A
Date of pumping 6/27/2017 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 8/1/1967 Soil rating (g p.d./ft2 or ft2/bdrm) 85 System type CRIB
Length 20 ft. Width 12 ft. Gravel below pipe 8 ft.
Total depth 12 ft Eft absorption area 516 ft` Monitoring tube Y Depression over field N
Date of adequacy test 7/5/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 4 in Water added 462 gal. New depth 23 in.
Elapsed Time: 1440 min. Final fluid depth 4 in. Absorption rate >= 450+ g.p.d.
fJS
Any re)uvenation treatment (past 12 mo.) (Y/N & type) If yes. give date �1ttt
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
• Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 1 0+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
'P eX ; h1 e,U 13 a Pi .}- W W . ' I ( (CCi,n �) Cis
&ivvil uAS atvre6 r JVCt i, .- . .,t.\c i D1(-1 j -k -
G. ENGINEER'S CERTIFICATION -11.7a,,,,OF Aqk
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
_sod.'
*•49 TH %\ *�Y/
conformance with MOA COSA guidelines in effect on this date. . •••. •
Steven Pannone •�
Engineer's Printed Name r en' .•Pannone
Date 7/18/2017 �� ?:-.. CE-8149 )
COSA canary sheet_2-6-15.doc
S89°59'19"E 160.00 Lot 9 5647
30
O o
a o
o j o
o ,� o
Lot 10
O
Lot 3
Septic ven
O O
o o
Co c^) I
o0
°
O 0
z 0
57.9 - 0
z
q89°59'19"E 160.00 y
24.0
— — — _ _
E lik
°' "lanter
O Ain.
O = L 1.5 O +�
3 O a)
O �j "'
cY I N Q +-'
cv
Wel hous 22.5 1.5 OH N
Lot 2 Q LU �n�j Q. ` . O C
o " 4.0 0 1.2 0 `` aiar. - . Co 45
Q may (Y) -10
o C)
\\\\\� 0
Lot 11 ` � � o
z s" z
Wood fence 30 C
- - I d d / A` I / , r r I 8 , 1
S89°59'19"E 160.00 AS-BUILT NO CORNERS SET THIS DATE
Lot 12 I RECERTIFIED 6-20.1 I hereby certify that I have performed a Mortgagee's inspection
i II
' '�► of the following described property: LOTS10& 11. BLOCK 3,
a+���� r It in VALHALLA SUBDIVISION
Air",c�'• •OF •' '4 ;95 i� Hncnorage Necororng Precinct,Aiasica, ana tnat me
. 1 ' 'r i improvements situated thereon are within the property lines
f �' 4•th J" •'� / and do not overlap or encraoch on the property lying
>�• • ` * " adjacent thereto,that no improvements on the property lying
�1� �•• 1• of adjacent thereto encroach on the premises in question and
/0 1\"% , - that there are no roadways, transmission lines or other
.Brett A. Wilmot .3f visible easements on said property except as indicated
,/ " •
, • 112392- LS •'° hereon.
' F•'c'e • • yDated at Anchorage,Alaska
SCALE: 1"= 30' °Aq • • • • • •J.a° this 18th - day of OCTOBER , 1973.
■ 1 °fi,SSI°NAA- �
EASEMENTS OF RECORD, OTHER THAN %,� 1 �N.%416' FRED WALATKA&ASSOCIATES
THOSE SHOWN ON THE RECORDED Engineers and Surveyors
PLAT ARE NOT SHOWN HEREON. HVL BE (907-248-1666)
i,,~' GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Time of Inspection ~., ,~.q_/~! Oo fi '/~,
Date of ~ns~eotion__~____.
REQUEST FOR APFROVAL OF
I~VIDUAI. SEWER & WATER FACILITIES
FOR
...... C~-<~ ~ ~-,_/,,/~ ~,
5. ?vpe of Facillty to be Inspected,
Number of Bedrooms'.__:
Phone
'7.
O. Seepage Pit: 1. Size 2. Material
~. Disposal Fteld: Total Length of Lines
Distances:
A. %~'el/ To: Septic Tank , Absorption Area
Sewer Lines
Nearest Lot Line
B. F~undation to Septic Tank
, Other Contamination
AbSorption
C. Absorption Area to Nearest Lot Line
Requast for Approval of lndivi~ual Sewer ~ Water Faoilitzes
Page Two
~. Comments=
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTE~
, Da te~.
I certify that the information contained in this request for appreval to be a true
and accurate representation of the subject sewer and water facilities located ~t:
Signed Dage
HEALI'H AUI'HOR Y APPROVAL
IND VlDLIAL WATER SUPPLY AND SEWAGE DISPOSAL
PART I.--TO BE COMPLETED BY FHA
MORTGAGOR OR SPONSOR
SUBDIVISION NAME
WATER SUPPLY BY~
E~] Public system
SEWAGE DISPOSAL BY:
E~] Public system
IPROPERTY ADDRESS
] New installation
' BLOCK NO~__ 7 LOT NO. '~ "'
DYes
~o. o! SYSTEM DESIGNEO FOR
E~ Community sysyem [] Individual
[] Community system [] Individual 3 [[~1 Yes [] No
PART II.~TO BE COMPLEYED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SRETCEI
It is tbe opinion of the [] State [] Count'), l~] Local Department of Health that this individual water-supply system
'1~ is [] is not satisfactory as a domestic water supply for the subject property,
It is tbe opinion of the [] State [] County ~] Local Deparnnent of Health that this individual sewage-disposal sys-
tem witb proper maintenance:
~1 Can be expected to flmction satisfactorily, and [] Cannot be expected to function satisfactorily
~s not likely to create an insanitary condition
DATE SIGNATURE J TITLE
spaces provided.
Use of the above grid for Health Department Inspector's sketch as weU as use of the back of this form 1s at the option of the
heaDh outhorDy,
PART Ill.--FOR USE OF FHA OFFICE
TO ?HE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent PHA Compliance Inspection Report, and recommend that the
Individual water-supply system be considered [] Acceptable [] Not Acceptable
Sewage disposal be considered [] Acceptable [] Not Acceptable.
DATE
HEALTH AUTUORITY APPROVAL FHA Form 2573
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool.
Septic Tank~
Distance from well,__.fcet. Material,
Total liquid capacity,
Inside length, feet Inside width,
Cesspool:
Distance from: Well fret; foundation,
Inside diameter, feet. Depth,.
gallons. Capacity inlet compartment, gallons.
feet. Liquid depth, feet.
feet; nearest lot line at [] front, [] side, [] rear,_ feet.
feet. Liquid capacity, .gallons. Lining material
SECONDARY TREATMENT consists of ~] Tile disposal field.
[] Seepage pits. Other
feet; foundation,, feet; nearest lot line at [] front, [] side, [] rear,
feet. Number of lines, Distance between lines,
inches. Total effective absorption area in bottom of trenches,
feet, Depth, top of tile to finish grade,
[] Broken stol!e. Other
inches.
Depth of filter material over tile,
Tile Disposal Flold~
Distance from: Well,
Total length of tile lines,
Trench width,
Length of each line
Type of filter material: [] Gravel.
Depth of filter material beneath tile,~
Seepage Pits:
Number of pits Outside diameter, feet.
Distance from: Well, ____feet; building foundation,
Inspection made by~ [] State.
feet.
square feet.
inches.
Date of inspection
Depth, feet. Lining material
feet; nearest lot line at [] front, [] side, [] rear,
[] County. [] Local Health Authority.
Inspected by-
19
inches.
feet.
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main feet. Size of main,__ _inches.
Individual wells [] are [] are not customary in neighborhood.
Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water_
Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems.
Lot size: feet wide, feet deep. Dwelling set back from front property line,, feet.
Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well.
Distance of well from:
Building foundation
cast iron sewer,_ feet; tile sewer,
seepage pit,. feet; cesspool,
Well constrectlam
Diameter, _inches. Total depth, .feet. Type of casing,.
Approximate deptb to pumping level of water in well, feet. Approxfinate yield,
Sealed watertight to depth of feet.
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill.
Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No.
Pump= [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity,
Located in: [] Basement. [] lhlmproom off basement. [] Pumphouse above ground. [] Pump pit.
Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No.
Type of storage: [] Pressure. [] Gravity. Capacity, .gallons.
Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date.
Quality of water [] is [] is not satisfectory for human consumption.
Installation [] does [] does not comply with approved exhibits, if any.
Inspection made by: [] State. [] County. [] Local Health Authority.
Inspected by
Date of inspection , 19
feet; nearest lot line at [] front, [] side, [] rear,~
feet; septic tank,. .feet; disposal field,
.feet; other sources of possible pollution, feet.
Depth of casing
.gallons per minute.
.gallons per minute.
feet,
feet;
19
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
( ~]1 out in Triplicate)
~Iame of person requesting approval__
3. Legal description
4. Number of bedrooms in house
5, Water Analysis:
a. Bacteria], ,i)~:l
b. Detergent ~_~ z
Well data:
a. Type.
b, Depth ....
c. Casing Size
Distance from well to closest existing or proposed:
1. Sewer line
3. Seepage Area [~,(~
esspoel'
5. Property Line %~ .
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, bamn, drainage ditch, etc.
7. Sewage disposal system.
a. Age of system
c. Name of septic tank manufactu~e.r ~ ,:_¢', ,:- , ., -
1. If "home rr~ade" show diagram on reverse side of this form.
Disposal field or, seepage pit size and type
1. Distance to property line [:~, to house foundation
r-~
Sap~e~be~ ll.
Mm. Chamlss B. Bowdsn
WtldePn~ss Lane
Anchorage, Alaska
SUBJECTI On-site Sewage Disposal
System - Lots 8. 10, 11, ~ 12, Blo~k
Vel Halls iubdlvisien
Dea~ Mm. Bowden~
Tlla Greate~ Ancho~aze Area Borouah Health Department will approve
the installation of a l~200-gallon liquid capacity septic tank
installed to serve the sub~eot property.
Tibia lette~ is :o so~ve aa prelimina~y appmoval of the ~ubisct
sy8tei'~. Final approval will be given on completi~ of on-site
inspectioa by this office p~io~ to backfill of thio system.
Please con,act u~ as much as possible in advance of baekflll tn
o~der that we may perform the final inspection.
DAVID R. L. I)UNCAN~ M. D.
RJS/s~m
BY~
Roge~ J, Soibe~t~ Sanitarian