HomeMy WebLinkAboutGREEN FOREST BLK 2 LT 6Green Forest Block 2 Lot 6 #018-011-09 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: OSP251090 Work Type: SepticTank Upgrade Tax Code Number: 01801109000 Site Legal Address: GREEN FOREST BLK 2 LT 6 G:2833 Site Mailing Address: 12421 SILVER SPRUCE DR, Anchorage Owner: KENDRICK CHRIS M & STEPHANIE G Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 4/22/2025 4/22/2026 22712 ❑ Disposal Field ❑ Septic Tank 2 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 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 4 Received By: 7`- l—C r- Date: Issued By: Date: Z 2j, "Z S� ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-011-09 Property owner(s) Chris Kendrick Mailing address 2701 Flyway Ave, Anchorage, AK 99516 Day phone Site address 12421 Silver Spruce Drive, Anchorage, AK 99516 Legal description Green Forest Block 2 Lot 6 Number of Bedrooms 4 Engineering Firm Forge Engineering Building Permit Number Not Applicable RN APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field ❑ Initial El Septic Tank El Upgrade n. Holding Tank 0 Renewal EJ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: I -f V C- 6 '7-�,-v k T �Vr,_ C.L Distance: To / Permit/Rush Fees: z 2 <�- Waiver Fees: Date of Payment: Date of Payment: Permit No. L 0 J c Waiver No. 0 S V ()I April 22, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Green Forest Block 2 Lot 6 - 12421 Silver Spruce Dr Waiver request – well to holding tank Dear On-Site Services Engineer: The holding tank on this lot has aged to the point where it needs to be replaced in preparation for the sale of the home. However, when the well was drilled in the 1970’s it was placed in the center of the lot, with the required 100’ separation radius covering basically the entire lot. There are records of a waiver from 1991 documenting the separation. The holding tank appears to be necessary on this lot- there was an original septic tank and crib on the lot which seems to have failed before very long, and the existing tank was installed in 1981. None of the test holes in the municipal records show any perk rate, and the original test hole done in the 1970’s classifies the soil as CH, inorganic clay. Due to the location of the well, it is impossible to achieve required separation for the replacement tank. However, the tank is downhill from the well with the existing building in between the two. There is no possibility of effluent running out of the tank and contaminating the well head. Any overflow of effluent would flow downhill away from the well, toward Silver Spruce Drive. In 1990 a water sample was taken that indicated no bacterial contamination and no nitrates, so the existing location of the tank was not causing any issue with the well. We took an updated water sample on 4/14/25, and that sample also noted that nitrates were below detectable limits and there was no bacterial contamination. This indicates that the current location of the holding tank has not led to any effluent contamination of the well. This property doesn’t have a well log, and many of the properties around also lack that documentation. However, we were able to find three well logs of neighboring properties. Legal Depth Pertinent soil information Green Forest B2 L1 100’ Moist clay from 17’-35’ Green Forest B2 L2 150’ Clay from 6’-45’ Green Forest B2 L3A 161’ Silt from 2’-12’, gravelly silt from 35’-85’ Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251090, Curtis Townsend, 04/22/25 These well logs all show depths of 100’ or deeper and layers of silt or clay that would slow down effluent travel before it would reach the aquifer. Added to the clay that was documented on this lot in the first 10’ of the soil layers, it is evident that the well would be protected from any runoff or leakage from this holding tank. We have located the replacement tank as far as possible from the well, and this is an improvement over the current location. There is no way for the contractor to install it any further from the well. For this reason, we request a waiver be issued for the 70’ separation to the tank from the well. Sincerely, Benjamin Schiller, PE ® ® 1f cnq S Municipality of Anchorage Drpnrhnant P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite DevelopmentiDivision On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV251018 COSA#: Permit#:OSP251090 P I D#: 018-011-09 Legal Description: GREEN FOREST BLK 2 LT 6 Engineer: Forqe engineering Your request for a waiver of the required 100 feet horizontal separation from the holding tank to the private well has been approved. The approved separation distance is 70.0 feet. This waiver approval applies to the proposed holding tank only. Any future upgrade to the on - site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: LApproved by: Name of Reviewer **** VARIANCEMAIVER REVIEW **** // // // // // // // // // // // // // Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND GREEN FOREST, BLOCK 2 LOT 6 FEET 0 30 60 SI L V E R S P R U C E D R I V E 4-BDRM HOME SEPTIC PLAN 4/3/25 10' UTILITY EASEMENT SHED DECK SHED SHEDSHED 10 ' U T I L I TY E A S EM E N T FND. 3 4" PIPE (NOT HELD) BLOCK RETAINING WALL BLOCK RETAINING WALL REMOVE EXISTING 2000 GAL HOLDING TANK EXISTING 1000 GAL CONC SEPTIC TANK NEW 2,500 GAL HOLDING TANK MAINTAIN 10' SEPARATION FROM FOUNDATION AND PROPERTY LINE LOCATE AS FAR FROM WELL AS POSSIBLE EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251090, Curtis Townsend, 04/22/25 N8950'24"E174.75 OF A(q�;�p 49 TH oo THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS �f Imo` AOI NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. ° Q 9' SHANE A. HOLT .' i NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE O� PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. LS-6914 p g p ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ��°fessiona� �o ONLY VISIBLE IMPROVEMETNS ARE SHOWN HEREON Q . SEWER SYSTEM P/PE AS -BUILT SURVEY 1 " = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVEPERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT6BLOCK 2 GREEN FOREST SUB. UNITI (PLAT66-134) ANCHORAGERECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED DA LED A T A NCHORA GE, A L A SKA THIS 22 NO DAY OF MARCH 2O25 16227 240-65 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 Received Date/Time 04/14/2025 12:10 04/14/2025 11:00Collected Date/Time 1251410001 Matrix SGS Ref.# Client Sample ID Green Forest B2 L6 Client Name Project Name/# Printed Date/Time 04/17/2025 14:14Forge Engineering Inc. Technical Director Stephen C. Ede Green Forest B2 L6 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS HBL04/16/25EP200.8ug/LArsenic 04/15/255.74 5.00 (<10) B Waters Department AJP04/16/25SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)C Microbiology Laboratory HBL04/14/25SM21 9223B100mLE. Coli Negative 1 A HBL04/14/25SM21 9223B100mLTotal Coliform Negative 1 A 2 of 5 C :AAark 3egi&r mayor Oevefap ;tent Services Oepartiment Euilding Safety Division Jn-Site ,eater -&. Wast-vjc7er proararn 4100 3ragaw 5 1 rest P.C. Box 196,10 rcharole, A1' 99519-'550 ,.1jwwmuni "arl/nnsir¢ (90 7) ?43.790? Pump Installation Log ell I)r-Eina Permit ffumber: SW rcel Identification Number:_ ;al Descriptian G keee�r� r© v /3 L,- (e mp Installation Date: 3 V , liz Date of Issue: 01�,-oi1- o� Property Owner Name & Address: CAZ I -/JA?ic,< I , 12 y2/ .S'�ure v`i Ute' mp Intake Depth Below Top of Well Casing: feet mp Manufacturer's Name: 70-jj,44c 73 mp 1YIodel: ;>mp Si-ze l2 hp less Adapter Burial Depth: hY feet Bess Adapter l`rlanufac;urer's'iame:rN,'" Hess A da�tzr nstZller ✓;- .1— a �mments: xmp lnstaIler N ame ttendo n: T%e pump installer shall provide a pump installation 109 to the DSD Within 30 days of pump meailatiana Development Services Depertmen' 0 Building Scfety Divi --ion On -Site Wccer a Wcstewcter Procrcm 47100 Er0X Sweet p.0: Sax I9 156670 ts c' mark Anchcruie. AK 59719-56:0 maycf n•um ern/nrprs w (?OTj 243.7904 Pump Installation Log Well DrMin; Per colt Number- SW_ . Date of Issue: _ Parcel Identification Number:_ Leval Descriptioa Properrttyy Owner Name & Address: GIa e, I<�tn)i7Rl c.l< C7.4reen fo�rii� L32 L 6 t 2 e121 5. IJeh S/Frz V C Boz Pump Installation Date: 20 _O 5 pump Intake Depth Below Top of Well Casing: r feet Pump Manufacturer's Name: r, -r ej cIC.i� pump Model: -C &J— Size I by Pitless Adapter Burial Depth: / D feet PitlessAdapter Manufacturer's Name: Pitless Adapter Installer: Gd s row°-� ;Veil Disinfected Upon Camoleconn. Yes U No Method of Dislnfe_t-on: ,.e- Comments: Pump installer Name: ,40F57a- At:ention:' The pump installer shall provide a purap i=Wlation log to the DSD within 30 dajs of puma in.-allaticm. --�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMEN'T'AL. ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2.64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR VVEl_L INSPECTION REPORT NAM�� ? �__.,._._.�.._�_....�-.�_��._._� PHONE Jj j❑�.NEW -----�-r�CFa/:uFCRADE� MAILINGADDRESS _ LEGAL DE CRIPTION - LOCATIO , ` d NO. OF: ROOR45 �, Well DISTANCE TO: Absorption area Dwelling �� U Y ---- -.\ 1 w 4 Manufacturer Material Liq. capacity in gallons Inside length Width IF HOMEMADE: � PE ITT NO. NO. 16 , Nom . of compartents Liquid depth Well® Dwellin--. 1 DISTANCE TO: � g `� ( p� �NiateriaJ:•- PERMI �. z Q b Manufacturer !7� ,� �_- I'S llin`e`� Li ui ci i (Ik g r�gallons J'�J J u Z F' zcc F O Well Foundation Nearest lot DISTANCE TO: No. of lines Length of each line Total length of lines Trench width inches Top of file to finish grade Material beneath rile inches PERMIT NO. Distance between lines Total effective absorption area W Length Width Depth �� �� PERMIT NO. Qa. N w� Type of crib Crib diameter Crib depth Total effective absorption area LU V' DISTANCE TO: Well Building foundation - ---- Nearest lot line J J w Class Depth Driller s Distance to lot line PERMIT NO. DISTANCE TO: Building foundation g Sewer line Septic tank Absorption areas) OTHER - - I - PIPE MATERIALS SOIL TES `RATING /Gti - INSTALL _ EMARKS r .�xTj -- - - 5Pr' - - I - 4A" . I N APPR VED DATE LEGAL MUNICIPALITY OF ANCHORAGE r� Department Health and Environmenta- rotection V CT ?i 825 L Street, Anchorage, AK. 99501 264-4720-.'-• # # HANDWRITTEN PERMIT 3• WELL AND/OR ON-SITE SEWER PERMIT Applicant: 'N;�. :?ailing Address: S /9- Location: Phone Number: Legal Description: �()% /�'/E�� �1���-� ��,/Lc^',j�ot Size: Type of Soil Absorption System Is: Trench: ES Drainfield: Seepage Bed: Holding Tank Maximum Number of Bedrooms: Soil Rating(sq.ft/br) POO The Required Size of the Soil Absorption System Is: DEPTH �� LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED S( C(HOLDING) TANK SIZE GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 1 # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) 1 will install the system in accordance with codes. (3) I understand that the on-site sewer system may re ire enlargement if the reZ'danc is remodeled to include more that edrooms. Signed: ar / �N Issued by: �� _ A licant � Date: _ � - �-- k/ SWP/024(1/81) 0 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 6-G50, Anchorage, Alaska 99502 276-222T TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: �- �' II\ [rr j'2'�' DrATE PERFORMED:_�� � LEGAL DESCRIPTION: l___.p-T-. co" DEPTH Sbt] SLOPE_ _ SITE PLAN FEET r �' 4,rrwurr. r� 2 -- f i �LLy �7 /�KP�/ ✓It_r ISI _ 4 �� Qhltt>c r� Fznvt�t_ 5 --- N efl v/t.r V� L L_ / 6- 7 7 �� t'�hl•.l amu. �rr� / l 8 11 WAS GROUND WATER S ENCOUNTERED? _ ES L' O 12 CnLILLtN�P r IF YES, AT WHAT E 13 DEPTH? 14 15 16 17 18 19 20 Reading Date _ Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (mi nu tes/i rich) TEST RUN BETWEEN _. FT AND _. Fl- a `, -- COMMENTS �1.,1`�T7�2_1_ FFT7 Z �i"'GTPII� Oz<2---- / PERFORMED BY:. [-,QV"Nk'S[r i .i�LL \ nLt�� f7 CERTIFIED BY 72008 (7/76) t�, solLs Loc MUNICIPALITY OF ANCHORAGE r, i 4 U PERCOLATION ®� �`; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6650, Anchorage, Alaska 99502 276-22.21 —/r SOILS LOG — PERCOLATION TEST PERFORMED FOR: l �. ���J \� -----DATE PERFORMED: LEGAL DESCRIPTION: I __-T__ C' E" Zj"� 1 2 �2owM S6"p/ St l ­—"r t 2At�1 po tJ� 3 e5,2AVQ? L_ S 'n'n 4 L"�'Yc-:-`zS' 5 6 7 8 9 10 11 12 — �ot-7s�t,__ C7Y�1 �A 13 \2." 14 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER J S ENCOUNTERED? ! EJ L♦ – o 7wu,�_w P 7 - IF IF YES, AT WHAT -- DEPTH? Reading Date Gross Time r Net Time Depth to Water Net Drop F:' Lf -/1' r � f_r-� //ir.-' "� � DATE:411.-.--le, c-) PERFORMED BY: -t �-OMV G �-� `n CERTIFIED BY: PERCOLATION RATE (minutes/inch) 72008 (7/76) TEST RUN BETWEEN ._-- FT AND FT COMMENTS rr F:' Lf -/1' r � f_r-� //ir.-' "� � DATE:411.-.--le, c-) PERFORMED BY: -t �-OMV G �-� `n CERTIFIED BY: 72008 (7/76) March 3, 11978 07735`) wait 11080 Steer l.outo A Box 1.512•-V Anchorage, Alaska 99547 subject: Permit. 'mciAration A +acarrlit is:slz+7d Iry tha.g d.epelrj--nnjlt for well zujd/o on-site saewor i,zstall.ration on Lot 6 Block; 2 (;roan. n. Por4mt~ Subdivision has expirea since the issue date exceeds one(l) year. in t:ho�- ovent you st:ul plan to Install, the: well and/car on- sait e Sewer nyrstF'm., a new permit if; required, Tho Origi,llal soil test may bc uierod to obtain a Current: Perini.to if the well has leer► drilled, n wol.i. log ghou.."Id be hent to this depart"rnent to docir.-font the i.nsstal.l.ation elates. :SIF you have any clue€ttjon3 regarding the above matt ere )Tease caontac;t: this office immediately at 264--87?0. Sincerely? Len SI. Buchholz, I4. Q. Senior xnvironmental Specialist LzIB/l j i i TYPE OF SDIL 88SDRBTION SYSTFM IS� TRENCH MHXIMUM NUMBER OF BEDROOMS � ] SOI TI (SQ FT/8R>= ]50 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYS��N IS/ THE LENGTH DlMAS ION IS THE LENGTH (IN ) OF THE TRENCH OR DRRINFIELD� THE DEPTH OF H TRENCH OR PIT IS THE DIS E BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF T TON ( FEET) THERE IS N0 SET WIDTH FORTR H \ THE GRHVEL DEPTH IS TH477N f; I D H 0F GRRVEL 8ET�EEN THE OUTFHLL P7PE HND THE BOTTOM OF THE EXC�VHT�0N (r. EET) T" KI 171 0<101 to H 4: !;- i7i' EITHER H CLHSS\l OR II NSF �PPR LHNT MHY BE INSTHLLED" ^M~ IS Im Iff 1"N ON~SITE SEWERS HND WELLS HS SET 2� I WILL lNSTH|1 �T'FAM ����������HNC[�� WITH THE CODES ]^�I cf. TH�l E�'�UO�N�K��ES� � �F������IRE E�LHRGEHFNT IF THE �-~~�~'~_____-.-...' 5IGNE�.�HP|��[�F�A~'',` -` GRE. , ,:R ANCHORAGE AREA Bo. -JGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISP®SAL, SYSTEM — APPLICATION ANIS PERMIT PERMIT NO.. 77,3,0 NAME OF APPLICANT •� �� p MAILING ADDRESS ✓�l e/ /T` /"Pt �" pH ONEO INSTALLATION LOCATION _1_L�I/L� `` c -c LEGAL DESCRIPTION _z�- / 1 ✓ �� >( p G+� 2 �rl'tv � _ INSTALLATION OF: SEPTIC TANK SEEPAGE PIT—_DRAIN FIELD OTHER /✓lU-rNC" TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH ----__ SOIL TEST RESULTS rc o? r9 " TO BE INSTALLED BY COMPLETION DATE ANTICIPATED C(V K'f_'P,"7� �•r// ✓ O A✓ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL, TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK — DRAIN FIELD _— SEEPAGE AREA SIZE DRAIN FIELD SEEPAGE PIT _— DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL UACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I G.A ,A 11\ OR LICE-NSE1, DESIGNER TYPE DIAGRAM OFF SYSTEM I i - L ,� /1...t S Y�Jj;:S s y. 5-• j;�ct p( 7`l�'r�,.r�%� / I ;— e ell el - 1 � ' 1 / 1 ._ 1 � I I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. I DATE�� APPLICANT'S SIGNATURE ✓�-( `/ ) EQ -01 6(3-75) F NO. 28-68 AND THAT THE ABOVE GR TER ANCHORAGE AREA BOROLf"-'H HEALTH DEPARTMENT® 34� 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /'���� �,�- MAILING NAME �` ADDRESS 0.�aL �����`,�'4-'�`� PHONE= LOCATION oL'/ LEGAL DESCRIPTION ✓G°'> .�/l '?_ /%'l✓/ -21, SEPTIC TANK. i/✓/ DISTANCE FROM WELL / �' fel-✓l' MATERIAL G'-?x/NUMBER OF _COMPARTMENTS �_�,�✓.��'f✓' vsy-��!%'�7'/iii, LIQUID LIQUID CAPACITY G) e�C>' GALLONS. INSIDE LENGTH '---'-INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS J OUTSIDE DIAMETER OR WIDTH �G LENGTH �' DEPTH%, Cx OG' `fir: `Xi./�-�: ?�.� LINING MATERIAL -� �' 6-;� 2/ / �. DISTANCE FROM WELL ZC',G' BUILDING FOUNDATION / I, NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. '- TILE DRAIN FIELD: DISTANCE FROM W NUMBER OF ABSORPJfON AREA FOUNDATIO DISTANCE BETWEEN LINES SQ. FT, LENGTH OF EACH LINE EST LOT TRENCH WIDTH TOTAL LENGTH OF LINES , IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: 1-f✓ 4�� DISTANCE FROM WATER TYPE e</2,1 1l_ DEPTH BUILDING FOUNDATION. SAMPLE A� NEAREST ✓NEAREST `SEPTIC l SEEPAGE OTHER LOT LINE SEWER LINE ,TANK , SYSTEM_.CESSPOOL SOURCES 4 -- DISTANCES: DIAGRAM OF SYSTEM DATE _�C`---2`�• -� /� �/�'�' APPROVED-�ur- �I�Y /��/ice r�' r/ ..�.�i� -s./: sem/ ��r✓l/�ioiv-r .. s z ice% , s.'fi 7r✓ i W - <--�o � y 7 r1�y DATE _�C`---2`�• -� /� �/�'�' APPROVED-�ur- �I�Y /��/ice r�' r/ ..�.�i� -s./: sem/ ��r✓l/�ioiv-r .. s z ice% , s.'fi 7r✓ i W - <--�o � DATE _�C`---2`�• -� /� �/�'�' APPROVED-�ur- �I�Y GAAs-an-2 GR i ATEI ANCHO AC'T AREA _ 3ROUGH Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT/L!LC�tiLMAILING ADDRESS KJ RESIDENCE ADDRESS LEGAL DESCRIPTIO APPLICATION TO INSTALL: SEPTIC TANK_ " , SEEPAGE P11 TO SERVE THE FOLLOWING FACILI FINANCED THROUGH , DRAIN FIELD , OTHER PERCOLATION TEST RESULTS THIS IS TO SERVE AS ANTICIPATED DATE OF COMPLETION_ It&x7 BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF ""UNIT TO B� SERVED SEPTIC TANK SIZE Z2 ~ , TYPE(OF�s?aL 2 _ SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: HEALTH AUTHORITY OR LICENSED DESIGNER ' -c e 1C 2 TYPE 661 � < r I certify that I am familiar with the requirements of Greater Anchorage Ares Borough Ordinan e No. 2 68 and that the above described system is in accordance with said code. ��c ��`� ��� `,— DATE .`'� _ APPLICANTS SIGNATURE � _ G MATIM hNCHO'" SnA nv"wj"C!"L HUALTS DQ!T Y"7%'- g?T EAM ANCHORAM. ALAYNA ME Performed LOW Pe Qr, i ' TS ycry Re.orts �1! S.C. c. SQ The .,e was 501)le (A lie soil LL, f gas r i'm c4rLli C k. Cil bw D : i Ol U a t 0" was Ground Water En count e red?._,AUl if jes, At KaT Gross Ane Nei Time Denz! to M I Net Dry rropo Ir re n Mph Eepth To ;nt tam of Po I L: COMIENTS: Test Performed MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services C DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 0 Icq 0 11 _ 0 9 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone : (home)-�f �Z�(' Z Business 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: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms S� 3. WATER SUPPLY Individual Well,$ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation_ from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Fev. 7,88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KN�C7 L� L`7✓�rti-Z�'^'� Telephone Address �4-ri AlI4�—^j Date 12_ A -Z o —1 U nF A 6. DHHS APPROVAL Approved for bedrooms by A'.,• D V�"` Date Approved Z Disapproved _ Conditional Terms of Conditional Approval CAUTION113ARN ars. 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 72-025 (Rev. 7/88) Back Page 2 of 2 J0 5�OP. � r A. WELL DATA�p Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 P(Li v 4-1 if Legal Description: If A, B, C, D.E.C. Approved (Y/N) IVIA Well Log Present (Y/N) _ N Date Completed '�V /�?70 Yield i, -,2S Total Depth'(` IG) Cased toy 4 Depth of Grouting — aNk, Static Water Level %o Pump Set At /,/4/-- Casino ,/4/--Casing Height Above Ground7 L.7> Sanitary Seal on Casing 1Y/N) Electrical Wiring in Conduit (Y/N) tDepression Around Wellhead (Y/N) ill U SEPARATION DISTANCES FROM WELL: i To Septic/Holding Tank on Lot S..(i.t 64 ; On Adjoining Lots 7 �0 To Nearest Edge of Absorption Field on Lot 1 r"til �.' ; On Adjoining Lots To Nearest Public Sewer Line __`/ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ice` 2S t Water Sample Collected by Le N ( 0?�� ; Date 12 Water Sample Test Results Comments eL 0, 13. SEPTIC/HOLDING TANK DATA I4f7G Date Installed (9 Size 4-(/fV i�vu-No. of Compartments / d- G Standpipes (Y/N) YS -Air-tight Caps (Y/N)t�C S Foundation Cleanout (Y/N) /UU Depression over Tank (Y/N) N () Date Last Pumped 1 2 ,F -C U ' i 4c ) Pumping/Maintenance Contact on File (Y/N) /V6' ; for (� Holding Tank High -Water Alarm (Y/N) L S Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTI/HOLDING TANK: . 0= >/'t[- ti 4_ To Water -Supply Well ivc.h:,b- �--r` To Building Foundation To Property Line To Disposal Field i / /L.//,4 i1 To Water Main/Service Line N (4 To Stream, Pond, Lake or Major Drainage Course Comments S t pail % /lam! wL 5C7-)' -44) V-1 b /tic- 40 72-026 (Rev. 7/88) Front Page 1 of 2 d 1 Z abed ;uawf%ed ;o a;ea �— Q/� $ :aa3 aan!eM Q — 'ON ;d!aoaH �" �rn •�.,t Nin � �� ® — wf lis .. ••S�'T _" w°°� NOVO WRIL "AOU) M -U $ :;unowV (2 S �� �17 �7 Z° °N;dlaoeU �� () ob 'ON VOW sedo �aepep• ® i/ �_" �.l ! —' L ! ale leas s,aaau!6u3 YYY ° v Auedw0O �� ���aoc•.a.••'°s}a-A ���� - > pawls ° Ao ����� -uo!;Oadsui s!q;;o a;ep ay; uo;0a;;a U. sa�llap!nb VVH pue VOW Ile 0; pawao;uOO ao 'pal;!aan 'pai!0ag0 ane4 I legl �(;!;aa0 I „;sonbou VVH;su!ebV bu!leH wooapaa pa;;!waad 108gO„ sluawwuoO (Na /A) sapoO le0!a10a13 VON s;aaW ;sal CoenbapV bu!anp soloAO bu!dwnd ao; pa;sal (N/J&) luaA le l9na-1 waeIV aa;eM g6IH ;SGA wnd,, - le !ana-i ,uO dwnd,, (N/).) ssaOOV/0104uen suolleO ul az!s suo!suaw!Q — pallelsul a;ea f NOIIV.LS 1d11 '4 s;uowwoO eaay a6eao;s al0!4aA ao 'eaa u!ilaed 'AMOof asanoO a6euleaQ ao ao 'axle ! 'puod 'weaa;S of (;uasaad;!) �oeq;nO of slo-1 5u1u!ofpV uO ' uo walsAS pouopuegV ao bu!ls!x3 01 au! -1 Aljedoad o ;sal AoFpi5apV ;sed ;o ejua ;uasaad sad!dpulels au! -1 901AAE)S/u!eN aa;eM of ;off uo!;epuno3 bu!ppe of — IIaM SlddnS-AeleM of X1313 NOIldHOSBV WOH3 3ONV1SIa NOIlVHVd3S ssaui!O!41 POO IaneaO Pla!3;o 41dap pla!3 10 416ua-i uf!saa wa;sAS;o adAI — ;sa_L AoenbapV;se-1 ;o s;lnsaH (N/,k) PIal3 JOAO uo!ssaadea eaay uoposgV;o;aa3 aaenbS Pla!d l0 4lP!M Pollelsul 81134 e;ea;S uo!;diosgV ui bu!leH sl!oS Vlba a131d N0I1dd0SGV '0 f 9• z 9 ,0 .�, the o I � 0 N D A w���- Gay o Deck 2 rn • I � Gal•a�rre s' 5k 1pVcI- IT $6 .� � �,�0,®�'G✓ G/, LZ' � y 358 � V/�lJEI' S'P Lot SurvevCerttficatlon .4 OF 4�6gpp Prepared by Ietha�nnwv P;•.....•Q�.•'3�0� 0� __1Yte dthepshown �•Profsional end Surveyor,dmcrondthortte imprOvern8ruoedMeeon 49T<i _ :, p. c� Scale." -30, Date Drawn: //o v, orewithinthempertylIrmond PO -P•• .••r.•. •.. �.�.. ..� do not orerl a p or arcrooch on Z adjacentpropertyondthatno 1 • • •••• inv vernentsonodjocerrtprop- Jerry L. Sherbohn o Field Book: l'18fefenae; ertyoverloporencroochonthe Q 'r �.p No. 4468. S ,�� 9� " premiseainqueoWand that �� �'y, •. .. ,�Q •y 1f Ar0 are nO roodwayS,uflllty to, .0 ��0� Legal Description: O lO L— �Y/°'�CN �GiG.r% SV G� V / / linesarothervislbleeosements �"�FesSI NAv�'F on sold property except as ���OV®0��� Pre pa red for: nd Gated Hereon. seal _ e �(,� C C it C s•rvA 77317 f 1; ANCHORAGE CESSPOOL, PUMPING ALASKA PUMPING SUPERIOR STEAM THAWING P,O. Box 110232 ANCHORAGE, ALASKA 99511 (907) 344.2632 3442453 344.7732 rMERIORPER NO. J PHONE FD�TE A7 I Dr -r- 'L— 199-0 (:9 L.) ADDRESO - =-up 0 0 05. ....... ............ ...... ... ....... ...... TAX RECEIVED By B TOTAL opo 0 jo All claims and returned goods MUST be 6 9 3 3) accompanied by this bill. '71ank"You PRMT 609� 11.Glvw' MMONN Municipality ®i Anchorage,1 4 i Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 10, 1991 Robert Kniefel Kniefel Engineering 8441 Miles Court Anchorage, Alaska 99504 Subject: Waiver Request for Lot 6 Block 2 Green Forest Subdivision Waiver Request #WR900064, HA900552, PID #018-011-09 Dear Mr. Kniefel: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 65 feet from the private well to the holding tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljm:#6 Concur: t //�� �ohn SmitK P.E. Program Manager On-site Services r� MUNICIPALITY OF ANCHORAC Dep-rtment of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR900064 PID# 018-011-09 HA# IIA900552 Permit Date Received: 12-28-90 Legal Description: Lot 6 Block 2 Green Forest Subdivision Engineer: Robert Kniefel, Kniefel ENgineering 8441 Miles Court, Anchorage 99504 Applicant: Gene Wooten Waiver Requested: well to holding tank - 65 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: .moi 7 7.67 2. 3 y 2. 9 Waiver is Granted: --< Waiver is NOT Granted: List Conditions or Reasons for above: SFE ATI .9 <FlFD_ Rec #: 22394/43SS Amount: $ 410.00 Date Paid: 12-28-90 L KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 9950411C (907) 337-1121 • Fax (907) 338-1874 December 20, 1990 Mr. John Smith, Manager On -Site Services Program Department of Health and Human Services Municipality of Anchorage 825 ,.L„ Street Anchorage, Alaska 99501 4%'/cin NO _ o, 4 pROT ECTj�I Ree SUBJECT: LOT 6, BLOCK 2, GREEN FOREST SUBDIVISION Dear Mr. Smith: The purpose of this request is to apply for a waiver on the well 'to holding tank distance for this lot. The current holding tank was installed at a distance of 65' from the well. The waiver would allow this 2,000 gallon holding tank to remain in its current position. The original system was installed on this lois, in 1970. the system included a 1,000 gallon septic Lank and a seepage pit disposal field. 1 -he field was a.pprox'imai;ely 65' from the well. The records show that during 1981 the seepage, pit was removed and a holding tank was installed. For this subdivision, the soils are very Light and a holding tank is used at numerous locations. The only paperwork mound in the 'files is the inspeci;ion report from Mr. John Kennedy for, the holding tank system. The current owner bought the property in 1981 based upon the approved inspection report from Mr. Kennedy. It appears the inspection report noted the well 'to tank distances as 100 feet, rather than the actual 55' or r35'. Conversation with the current owner shows the current well has been in existence throughout the entire period of the house and has not been moved or replaced. Our firm has completed a Idealth Authority test of the system and found the well to have good water quality, have adequate flow, and the holding tank alarm to be operational. The tanks were pumped on December 5, 1990 with the receipt showing a total of 3,000 gallons removed. It would appear the current owner- has grounds tor a cla-im on the MOA. This is due to my client having purchased the i o i; with the 1981 approval now to find the actual distances were not field measured and current measurements show they fall less than the required minimum. The existing septic tank meets the standard for its lime of construction and no additional work is needed on Lot G, Block 2, Green Forest S/0 Waiver Request, December 20, 1990 page two its behalf. The holding tank Tal l-, approxima=tely 10 =feet shoe ; of the required 75' separation, Due to the tight soil conditions on Liie lot, which necessitated the need for -Lhe holding tank in the i irst place, and the Iack of well, the waiver Tor, this iu ti'Ficat-1on. wat,r quality degradat-ion of the separation has subs=tantial The attached paperwork for the HAA and Waiver arc; being submitted for review and approval. Based upon the above information, the MOA should be able to approve the waiver request which then allows i,he HAA to be approved. We appreciate the opportunity to provide Lhis information and would ask for a sincere review of the above request. TT you have any additional questions or comments, please clon't hesitate '.o contact us. Respecttfu I 1 y Submi=tted, Kniefel Endineerirg Robert Knievel, P.E. W41VER lraL(F_fT fol? Lor 6 eLk 2 G/TFEti Fol,.c.sT"s4,a wv VEI? 8E u sT Ntwo --- - - tNpl_v_E 1?_ !�fQuEsr45p 6S- FRpar F-ct 7 /,�o�a�Ae-r19A-- ' 'leo r�,tiG- 7' Nlz- HI 5.708 y HOLTMV6 - TpN/�s- oIV 77-elf 4 c_r C'o,vsir i -o-F �r /oo© - Co,vc/P�i�' -- ----- -- 6#1-4-GAN f _ C_DM�ARLMENT�_SEY77C r/INIr - fl-- 200D �H.LLot'_ I�vHEA1 Pew. f EP_Zic _.r&VK- U< r► r1.0s74j. -p rl - - 1-i41t/ltri-ow- ,-: L G, -,r- N -- - - IS Y-s r w yrs _[ ay v_ /e_TrQ T 4 _!-Na[.n1A.6 --- - - GL�_�•�-/ocGitiG_ w- s- F, r9Lc'�-p_ 1,�_ s bRloF5- 17706. _ _G ti E/? I nt D rI-tESf /YO[. ✓,ti j, _ i�rN/rsPee d --TNS iTwja }_FiFrt'_.tf✓ERAL ._/J�}j'S-(<'-/%S ST'714 -- -_J0/Lf- 4 o&f /.c.,p/CITE 7%.szT 1�1 5_E_-T�_Alk r -- - -- GR_a _, EW )v rh/>�G,E- - Tar r- ry Y 7Fl? _ Tr_7 :__ 40ELMi- -- ------------- -- - RY4 s - __Hoz- p,tiG 7-h A-s- "�''E powti dGop !=/?�-•� - 7-/rte 4PP/P0a/1"47-6-L j'_ fit FFL.a,.v7-;4cu�,vG ruF-c,U- Ju 'Fri cE./`y/- $o _ L oC,g j EV _O Al d/'f'drrTE S/per ' --- - - - --- - - I'%%w LL/.r✓G- FRo&C i'' ---- � ;- -- - - - - - - ,j - -- - - _ - -__- _ _ _ - - ------ i -- ------ -- ----- - -- - -- ----- _- - - - --- - ------------- -- �: ��i - - - 7-A Ao Ir f /PE L/ IF I r-.Fx? yy /2- - TG_�N 7 r��/�-�,y X/Al Cl-lt' -71-oE 09 �.- qIv c/r (, a 1pe /�vl�" l��/.(/%_ f CPa ii �.� T w �a /� r�✓�. -_ - I--- --- - - _ 'i Time Time no Date Date Date Inspector Inspector Inspector ^ Comments Conditional Approval ll Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner E [�t __ z �+ 62 - � Phone Mailing Address's-/?/] Bon /3J�/� -/= ; /� 11C170leA 9C- X /( 9F-5-0 t" Buyer Q Address S/i'/1/.Snk /_5-/,2 �® Lending Institution '17e- /, e -p ,� W/L cy. ��(�� / Phone Address Realty Co. & Agent Phone Address Legal Description {� 4 �l � - (-D I / Street Location �'r' � //� / �¢� ((f' - U - Z r.? r.0 (?/z /�a f Ta, <11y Type,gf Residence — h5 Single Family 7�5 ❑ Multiple Family No. of Bedrooms ❑ Other _ Water Supply Il Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. SewELgge Disposal ,d 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. 7y/-� F_ - DAiERECEIVED INSPECTION APPOINTMENTS FF G-.-ae ° n Cot I 5 `� CL n -- 11 IME - TIME TIME ogrue. 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS - DATE F'' DATE ` DATE 0 ❑ MULTIPLE FAMILY Three ❑ Six INSPEC INSPEC R INSPECTOR MUNICIPALITY OF ANCHORAGE MU DEPT. OF HEALTH 8, PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT I011:, YIRONMENTAL 825 L Street - Anchorage, Alaska 99501 OCT 17 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED j REQUEST" FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER - _� �-PHONE - &C C\[1U` MAILING ADDRESS ay PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILINGA DRESS /tcr P-0. lhX 022 l K)CH C/RNrl r (-I (AS0?'a ct e1 5G) Z- 3. 3. LENDING INSTITUTION OVLV-S PHONE MAILING ADD ESS 4. REALTOR/AGENT PHONE /U( M r MAILING ADDRESS - 5. LEGAL DESCRIPTION -- - &. 2 FF G-.-ae ° n Cot I 5 `� CL n -- STREET LOCATION Sllt/�t�5P2uce ogrue. 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS - ❑ One ❑ Four ❑ Other__ SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY v� 9 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 - 9 'INDIVIDUAL/ON-SITE** 197Q YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 60 72-070 (Rev. 6/79) �-�(� ` _ _ •-t�_n -� � _-y� /rho --C - 5d4_ 3 coo THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY LOG RECEIVED Connection Verified___ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY DATE INSTALLED j o "1y Connection Verified _ INSTALLER ❑Septic a k or ❑ Holding Tank��� SOILS RATING - - Size: If Tank is homemade give dimensions: Q0 TYPE OF TANK MANUFACTURER �. TOTAL ABSORPTION AREA - MATERIAL 4. DISTANCES Septic/Holding Tank Absorpt 7nArea Sewer Line Nearest Lot Line WELL T0: Absorption. Area to nearest Lot Line - 5. COMMENTS C �✓�(twyr ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) En,—DISAPPROVED DATE BY - - October 22, 1979 Rev. Michael Roberts New Life Christian Center Star Route A Box 200 Anchorage, Alaska 99507 Subject: Lot 6 Block 2 Green Forest Subdivision An inspection of the subject property revealed the well. only seventy-one(71) feet from the leaching area. Therefore, before we may send approval to the lending institution, the seepage area or well will need to be relocated so that there is a orle-hundred(100) foot separation between the well and seepage area. If you choose to leave the seepage area and move the well, you will need to upgrade the leaching area because it was designed only for a one(l) bedroom single family dwelling. You will need to obtain a permit from this office prior to construction. If: you choose to move the leaching area a permit will. also be needed prior to construction. You will also need a permit if a new well is drilled. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 4-2090 99509 PC'i 1CH 6-650 AI CHOPWI'l-, 99502 .ALASKA it •' [ �y t .� i C,O/) 279 '1_11 4". ;g ray 'S SF'" 4: , : _ LIVE, IV. irk ttt Ili !>Et ri lr�iF NT Of HEALIHANDC .%Iii :;-iAi N 1£32') "L ' 5:.,-. October 22, 1979 Rev. Michael Roberts New Life Christian Center Star Route A Box 200 Anchorage, Alaska 99507 Subject: Lot 6 Block 2 Green Forest Subdivision An inspection of the subject property revealed the well. only seventy-one(71) feet from the leaching area. Therefore, before we may send approval to the lending institution, the seepage area or well will need to be relocated so that there is a orle-hundred(100) foot separation between the well and seepage area. If you choose to leave the seepage area and move the well, you will need to upgrade the leaching area because it was designed only for a one(l) bedroom single family dwelling. You will need to obtain a permit from this office prior to construction. If: you choose to move the leaching area a permit will. also be needed prior to construction. You will also need a permit if a new well is drilled. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 4-2090 99509