HomeMy WebLinkAboutGREENLAND BLK 5 LT 8Greenland Block 5 Lot 8 #015-171-41 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 2 www ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. S w Oso 363 PID Number. OFS- /"71 - y/ Name t hr Qct+� fD Wastewater System: [I New ER Upgrade Adq"° y621 .Tu^f ct�. i4 Ir l 99 —/6 ABSORPTION FIELD P�•NuniWr M aetroam 3 Y,4'- 3 26S 510"P Tr 3 O shanty Tram O bed O Mgnd O oe,er LEGAL DESCRIPTION SiM R"h°"pnep•d-BiotaLq Q• 8 GPD/hr h`om gpmy p ase It.S�.v/an�nam GrarM dWh MryLam pqM Ft.Twnamp RGl'• • V • Ft. onpne pads (6. p Fi Gravel Laigro0•� :R*= Fl. J-3 Ft.Well: IFASt ❑ New ❑ Upgrade s =Tq"Dapa Nunn. aN.f D-Vt be lii,,ef2 (Wi (Prnete. A S. CI Total Dope Cased to Ft.CIafLM1 �' Ft«W Ft% DreMd sulk Wer LavN Fl sDes D T s F-Eio Pe�fFL O ! r„«d Fl AG/1PSon Dn. Maaxad to / 3 / 2 �S' see Casing Heyry Atrov. Cy GM Fl. R TANK SEPARATION DISTANCES To Septic Absorption Lift p rp Holding ® Septic ❑ Holding ❑ S.T.E.P. aq„« ❑ Olher. uDINPnvale Fran Tank Field Station Tank Sewer Line w•��r AnCi+p/� e Tan k /�� � _ _ _ WNL t O 2 • 10 3' Me«w NwW« a Lompanma,lf 1-e el 2 Suri. We°r > /.c%�' > EC10 • _ _ LIFT STATION /v.�, LO Lm 210 O Ga Fqa . 19, F l ' / a C — — 'Pv an' Mve AN 'Py pe' Nv« a High walW arm e „ „ Cutan Dran — _ Pump Make a Madel •r ENdnce a,rpegronf padnmed W RenWf ON ^., l 1 c kc %un se un+ od BENCH MARK Z /r.d E IiK,"ree/ in ICCC a Loulgn ra Desrnpuon ` BOA10 O7-Sidin NW Ase ro..I. 244 Q�'Lt a FL Engineers Stamp ,ppCS14\e Inspections performed by: FlaFfoP Ticl. Sic "_% 9 /o — t' k'k • !'t' Dates: 1 /i ,t 0* argTH j; •ry .............•eaea.a... 2"d 9/29 /os Developm t Services Department Approval t'” :•••••••• •: ••.e; THEODORE F. JIOORE•.' Reviewed and approved by: Date: ,n' I''/Dc 6',4-. CE -3589 txry i-'pl �. •x • �: � \°-•• •i� fat`.• 4 • C` PERMIT NO: SW050363 PID NO: 015-171-41 SWING TIES: FROM: COR. "A" COR. "B' TO: S.T. C.O. "D" 21' 61.5' S.T. C.O. "E" 27' 64' DBL C.O. "F" 28' 63' TR. C.OJM.T. "G" 21.5' 43.5 TR. C.O. /M.T. "H" 71' 33' PLAN VIEW SCALE: 1" = 30' EOF Al *k g..... ,.. s� �) %THEODORE F. MOORE ji �•,•. CE :3589 �AtycL" "Zoo 101O�:� ar PAGE 2OF2 :......... .. -------------- hii. .................. LOT 8, BLOCK 5 GREENLAND SID WELL N ORIGINAL GROUND EL W. 96.0 4' SOIL COVER INV 91 4 INV 91 4 " � INV. 11000 -GALLON . „ 92.5' , SEPTIC TANK 53 -FOOT LONG SOIL ABS. TRENCH w. 6.8' EFF. GVL below, DIST. PIPE j LOT 8, BLOCK 5, GRE E10TTOM TRENCH ELEV. 84.6..;......!.:': SEPTIC SYSTEM l AS -BUILT INSPECTII BOTTOM T.H. #1 -- ELEV.78.5' PROFILE VIEW FLATTOP TECIINICALSERVICES DRY 9129/05 NOT TO SCALE 14530 ECIIO STREET N 0 S •� et N 89 53' 20"W _ Lot 8 ,Brock 5 JUln4R AVENUE - (5reen/ond Sufx�ivis%on Anchorage Recording District, Alaska OT SURVEY CERTIFICATION 1 hereby c..nry that I hate aarwayed the property shote ane described hereon, and that the Impwamann Situated thweoa we within the prop. wry Wns oed do not owrlep or ""mach on adjacent property and that no Improvw.«de on odlaoent property overlap or encroach on Ibe premised N dueolloc and that Mere we so roodwoyss utility lined, or other risible easements on sold property *adopt as Indicated harden. A R. L Bulto LS1192 LaNfNow nto of Mord other than tho" shown on Date Prepared by: R. L. BUTTON Stole o RegistdrodL&VSurveyor © 10-05-%C) 5 �907127Y-6200 &Y W. EiDhthAvi. AochxWe Almko95S0t Ret26.6 I F. B. No. O.S "07.3 I Property ot: a7/ / y QUin .0 -4 -A ROFC!-$0t1 the Nat of record ora Bot shows bereda coined, otherwise noted. LEGEND 0 Brass or Aluminum Capped monument recovered ct Iron pipe and/or robot recovered. 0 2 x 2 hub 6 tack recovered 0. i5/8" x 30" rebar set this survey —M Fence Line (Approx. Location) Date Prepared by: R. L. BUTTON Stole o RegistdrodL&VSurveyor © 10-05-%C) 5 �907127Y-6200 &Y W. EiDhthAvi. AochxWe Almko95S0t Ret26.6 I F. B. No. O.S "07.3 I Property ot: a7/ / y QUin .0 • MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water b Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50363 Legal Description: GREENLAND BLK 5 LT 8 Date Issued: Sep 22, 2005 Expiration Date: Sep 22, 2006 Parcel ID: 015-171-41 Design Engineer: 0019 Flattop Technical Services Site Address: 004621 JUMAR AVE Owner Name: BARRY QUINTO Lot Size: 18000 SQ. FT. Owner Address: 4621 JUMAR AVE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516 - This permit is for the construction of: ❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. Received By: 17:� `e '' Date: 912 7 /C�- Issued By: Ar� Date: 61 2z o Municipality- of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 615-191 -1/ Permit Number SW Propertyowner(s) )3ay Q.4 in 1w Day phone 2629-dZ-V Mailing address 99s-16' Zip Code 99.-1X{ Site address Snn+t Zip Code Legal description (Lot, Block & Sub'd.) "t 8, 6l6c4 .f eCo-iti 1AAPC Sib Legal descriptions (Section, Township & Range) Lot Size �Of��� Acr Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade Is THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. �/� I ";r 9;01� (Signature of property owner or authorized agent) Permit/Rush Fees: N60 Waiver Fees: Date of Payment: 91191'0'r Date of Payment: je Receipt Number: Receipt Number: (Rev. 09104) '.JF :ATTOP'TEGHNI%.;PCX ERV �G�.�' CIVI. & ENVIRONMENTAL ENGLNEERLYG • ENERGY CONSERVATION • ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 September 16, 2005 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: ANCHORAGE, ALASKA 99516 The purpose of this letter is to provide the required•design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 8, Block 5, Greenland S/D, located at 4621 Jumar Avenue. Soils logs, Pere test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 6 and 17.5 feet below ground level is sandy silt with a measured perc rate of 12 minutes per inch. Using the'soil application rate of 0.8 gpd/sq. ft. specified in the wastewater ordinance, this 3 -bedroom residence requires a total absorption area of (3 x 150)/0.8 = 563 square feet. The proposed design has a total absorption area of 676 square feet, of which 572 square feet is at a depth greater than 6 feet. The topography of the lot in the area of proposed construction slopes down towards the north northwest at approximately 8%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Z,.,e %i?.o-.s._ Ted Moore, P.E. LOT 6, BLOCK 5 GREENLAND S/D SEPTIC AREA LOT 5, BLOCK 5 GREENLAND S/D SEPTIC AREA LOT 4, BLOCK 5 GREENLAND SID SEPTIC AREA JUMAR AVENUE SEPTIC SYSTEM ..o • -------- LOT 3, BLOCK 4 ♦���_`�l` TALUS WEST SID #1 ��•r1�G.QF :4[ � ��� r- P�+ ........................ .� %• THEODORE F. MOORE i ��� •• CE -3589 ,t �o I� LOT 1, BLOCK 4 'TALUS WEST S/D #1 SEPTIC AREA -E; LOT 8, BLOCK 5, GREENLAND S/D SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECI IO STREET DRAWN BY TFM ANCI IORAGE. ALASKA 99516 SEPTEMBER, 2005 NOTE: THIS IS NOT A SURVEYED PLAT. ,,.SEPTIC SYSTEM ,,, • ,. TANK H. ABANDON EXISTING SEPTIC TANK BLOCKSEPTIC LOT 7, fNI1' 'IIS R109 JUMAR AVENUE SEPTIC SYSTEM ..o • -------- LOT 3, BLOCK 4 ♦���_`�l` TALUS WEST SID #1 ��•r1�G.QF :4[ � ��� r- P�+ ........................ .� %• THEODORE F. MOORE i ��� •• CE -3589 ,t �o I� LOT 1, BLOCK 4 'TALUS WEST S/D #1 SEPTIC AREA -E; LOT 8, BLOCK 5, GREENLAND S/D SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECI IO STREET DRAWN BY TFM ANCI IORAGE. ALASKA 99516 SEPTEMBER, 2005 NOTE: THIS IS NOT A SURVEYED PLAT. 52 C.O. M.T. -y — 4" DIA. D-3034 _ J DBL. C.O. INSTALL NEW SEPTIC TANK FROM HOUSE 11000 -GALLON SEPTIC TANK Iml 1 7 4" DIA. F-810 PERF. PIPE [01931 CONSTRUCT NEW 52 -FOOT LONG SOIL ABSORPTION TRENCH w. BOTTOM AT 11.5' B.G.L and DISTRIBUTION PIPE AT 5.0' B.G.L 3 CONSTRUCT 52 -FOOT LONG SOIL ABS. TRENCH w. 6.5' GRAVEL BELOW HORIZ DIST. PIPE CROSS-SECTION F'A - A" SCALE: 1" = 5' PLAN VIEW SCALE: 1" =10' CLEANOUT �.yc[1ut EO r�� d� Ftt 4t d..".✓•. •• rCj wrr n �� f1�9te1 �j� ••'•�� 4 14 .. ....�•• l>1 THEODORE F. MORE: i7 • CE -3589 • e4' R` .,n 1.,`x.1. F• �.S`; � MONITOR TUBE MOUND BACKFILL 12" ORIGINAL GROUND FILTER FABRIC 4" DIA. F-810 PERF. PIPE -1/2"- 21/2" SEWER GRAVEL BOTTOM OF EXCAVATION LOT 8, BLOCK 5, GREENLAND S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECI INICAL SERVICES SCALE: AS SI TOWN 14530 ECI10 STREET I DRAWN BY: TFM ANCI IORAGE, AK. 99516 SEPTEMBER, 2005 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 1 SOILS LOG — PERCOLATION TEST LEGA DEL SCRIPTION:_Lot 8. Block 5. -Greenland SID DATE PERFORMED: —August 29,2005 PERFORMED FOR: 8% Barry Quinto DEPTH (feet) � ML Silty fill material t (minutes) Pt. Original topsoil 2 �lf ( SM Sandy loam 3 �� 273/8 ML Light gray silt / Hard, chalky a 5_ -21518 ML Somewhat sandy silt 1 dd water, 12:03:30 Softer digging than above 6- ___,_ _ 7—a 7— __21 3/4 2312 _ _ 7 314 _4___ _ It3 EEE,:04 _ 30-21314 _ a . _ 1.3/4. Dry, softer digging Increasing sand w. depth 9 3 Lenses of SP near bottom - 0- 8% Depth to Groundwater i Date 4� Q�t.�a.C.Rtt1 .:Qf Rte°h hJ;•�THr� ���t? 1� THEODORE F. #AOORE X. SITE PLAN %NIII /IIIII I 39.5 130 �41 LOT 8,BLOCK 5 GREENLAND SID 3% Date Reading Clock Net Time Percometer I Net Drop Time (minutes) Reading I (inches) 82912' Presoak 273/8 _ _ _ I Start i 11:33 _ _2312 2:03-30 -21518 1 dd water, 12:03:30 _ 23 12 ___,_ _ :33:30 30 p212 __ Add water 12:34_ __21 3/4 2312 _ _ 7 314 _4___ _ It3 EEE,:04 _ 30-21314 _ —.a . _ 1.3/4. PERCOLATION RATE 12_ (minutesfinch) PERC HOLE DIAMETER —6" TESTRUNBETWEEN 7.5_FTAND,8.0_.FT PERFORMED BY FLATTOP TECHNICAL SERVICES. I .cr�/lf CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: rFYattop 7echnicafServices 14530 Echo Street,.Xncfromge,,gX 99516 ti fww (907) 345-1355 Lot 8, Block 5, Greenland S/D 4621 Jumar Avenue Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing septic tank and installing anew 1000 -gallon septic tank that discharges effluent into a new 52 -foot long soil absorption trench that contains a total of 7.0 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and grubbing necessary to complete the project. Prior to the start of excavation, the contractor shall cut down and remove the branches of all trees larger than 6 inches in diameter and neatly stack these trees outside the construction area. If requested by the property owner, the contractor shall then bury non -detrimental branches, brush and roots generated by the construction work at a suitable site on the property located no less than 10 feet away from all present and foreseeable construction areas. The contractor shall neatly stockpile any detrimental material which cannot be buried, for subsequent disposal by the property owner. 1.5 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1000 -gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Care shall be taken to ensure that the tank is outside the 100 -foot protective radius around the well on the lot. Each tank compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 52 -foot long trench to a depth of 11.5 feet below ground in the vicinity of the test hole. The long axis of the excavation shall parallel an existing contour. Prior to the start of trench excavation the contractor should excavate down to determine the exact location of the original trench. The east end of the new trench will probably need to be adjacent to the existing bam in order for the west end of the trench to not intersect the original trench. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 7.0 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 6.5 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. Municipality of Anchorage, -- Department of Health and Human Services 1PL� Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 17, 1992 Michael Anderson, P. E. Anderson Engineering PO Box 240773 Anchorage, Alaska 99524 Subject: Waiver Request for Lot 8 Block 5 Greenland Subdivision Waiver Request #WR920012, PID #015-•171-41 Dear Mr. Anderson: Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance is 89 feet. 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. Sincere Concur: Robert W. Robinson /ohn Smia. Civil Engineer gram On-site Services On-site ljm:#6 Services r-- 49 .S . C�Rc�NC✓?.f/i v b.O V ME 9cW0/ 2 L ol �/�. J ud�eG G /o wos Cuero le ✓ e -i °` 7-, u -e// e j liCI1 u tS 1,I: l4/21y� .711flil *4 G ,r Csf ted@ 93 Jl10 It GJele, Lew_/ _¢S• %.�a//G N//li. Zevel z11L19z, _ Z13' ,t/.7Z,I IAJS14 71V 140cC &11�.e41773N g9' d February 16, 1992 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reference: Lot 8, Block 5, Greenland Subdivision Subject: Separation Distance Waiver Dear On -Site Services Engineer: We are hereby applying for a separation distance waiver between the private well on the referenced lot and the septic system located on Lot 3, Block 4, Talus West Subdivision. The well is currently located 89' from the septic system. Water samples taken from the well indicate negligible amounts of nitrates, satisfactory coliform count and no other bacteria found. The location of the septic system is therefore having no impact on the well. The static water level in the well is 2.7' lower than the bottom of the septic system. The soil type between the bottom of the system and the water level is a dense nearly impermeable silt. It is extremely unlikely effluent from the septic system could penetrate these tight soils and contaminate the aquifer supplying the well. The attached cross sectional drawing illustrates the well in location to the septic system. In addition well logs from lots in the area show the static water level in the area. The static water level between the two lots in question appears to slope at a hydraulic grade of -10% from Lot 8, Block 5, Greenland to Lot 3, Block 4, Talus West. Since no evidence of contamination of the water table is evident in this area and the soils separating the bottom of the septic system and the static water in the well are nearly impermeable it appears a separation distance waiver is justified. Sincerely, Michael E. Anderson, P.E. Enclosures s s��:, 6' S, i n r o 3 > 7NI crJ c� ao�' S+roa9�ejioo �9 Michael E. Anc',mn n 4381 - o 0 SHEET NO. OF_ CALCULATED BY DATE— CHECKED B ATE—CHECKEDBB 7Y r DATE_— SCALE ._f_Li IZ' -2a1 VW; 64, Srri i `f�tC Eat � iVAT I C .Nm� 'Elk -.2 MO -U MI FA s Inc. Wqm. 14u DIM. I .Nm� MO -U MI FA s Inc. Wqm. 14u DIM. .Nm� 'Elk MO -U MI FA s Inc. Wqm. 14u DIM. J I 1tv J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME —' PHONE KNEW Ci. lYL.! �'—moi ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION j NO. OF BEDROOMS ? - y/ l� v _Y DISTANCE TO: Well Absorption area Dwelling PERMIT NO NO., w2! Q N ti Manufacturer ' Material Non of compartments �— Liq. capacity in gallons cam. Jo IF HOMEMADE: Inside length Width Liquid depth �-'DISTANCE 0Z TO: Well Dwelling PERMIT NO. z b Manufacturer Material Liquid capacity in gallons o w2 DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. �© �1 LU FL No. of lines ,. Lengthf eachtliirne Total length of lines Trench width ween lines Distance betf✓/ Q inches />✓ft ' L L I-. Top of tile to finish grade f Material beneath tile ,f Total effective absorotion area `b °6 Length Width Depth 5 f-rfrrmnr�ari b lti7l I-)yxf SiCSY. Type of crib Crib diameter Crib depth 1 W _ N Well Building fou. DISTANCE TO: a Cla'AA�� Depth �7, Driller -- , LU DISTANCE TO: Building foundation Sewer line r OTHER PIPE MATERIALS SOI L TEST RATING ,et INSTALLER 1 r REMARKS PI \0-' r 01 G•.2 y \\ ArrrtVv tV !,�(,L �.C!•J �,,� DAIS L[ L. Aj -I - N r -i (U: H 4f L`1 co� cr) V) co: (1) N r -i H U) co� V) co: (1) co: co: 0: 00 If) (A C) PQ Ge. p-] N r -i H U) OV (1) If) (A F; i- F-, F- F- F- P, N owl 11.1 N Z �1, L',I " F, �� ����... ���� DEPHRTMENT HEHLTH HND ENVIRONMENTHL .OTECTION (/` 7 / 825 'L' STREET/ ANCHORQ(3E/ HK. 99501 264~4720 « 1, 7, F_ PERMIT NO. (�4��t' HPPLICHNT JHMES L SCMEFERS SRH BOX 1687-H / LOCRTION KLHTT ROAD HT OUTCROP LEGHL LOT 8 BLK 5 GREEN LHND SUG LOT SIZE 18000 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUME:ER OF ] SOIL RHTING (9Q 25(.-1 // J/ d� ~ y�o THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� low EMT M W bi :1. Rai L. IE`E P"1 C71 W, B- I F.-'. L_ ���-"��� TH� LEN�TH DIMENSION �� THE FEET) OF THE TRENCH OF! DR�INFIELD THE DEPTH OF M TRENCH OR PIT IS THE DISTANCE BE.*:TWEEN THE SURFHCE OF THE GROLM) HND THE BOTTOM OF THE EXCHV8TIOki (IN FEET) THERE I� NO SET WIDTH FOR TFANCHES. THE 13F!HVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THEE BOTTOM OF THE EXCHVHTION (IN FE[E.T). �C-:�� NJ .11]. RE'E" ���1: fl::�:: ��I r -A V.-_ I F*._...". ���CE.,u ����fcD�� PERMIT HPPLICHNT HRS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DUR1NQ THE INSTHLLFITION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE ��. 10 �two �����F H. -D PA 0 1=1 FYI K Q E= Pit 1.j 1: M Q Q � BHCKFILLIN� OF HNY WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUT�ON MINIMUM DISTHNCE BETNEE:N H WELL HNY ON^SITE SEWAGE �ISPOSHL SYSTEM IS 100 FEET FOR H PRI/HTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO A PRIVRTE SEWER LINE IS 25 FEET HND TO H SEWER LINE IS 75 FEET. WELL LOGS HRE REQUIRED FIND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE COMPLETION. OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS AND CONSTRUCTION DIHGRHMS HRE HVHILHEMLE TO INSURE PF!OPT"�R INSTHLLHTION. �W W 14 1"" 3: Bit Q AR., E--. jr-1 F.:- F, A_., J_.. I THHl J.: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE HND WELLS H� SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL IN�TALL THE SYSTEM IN WITH THE COD�S ]� I m.DERs.;THND THAT THE ON --SITE SEWER SYSTEM MHY REQUIRE E1,41-ARGEMENT IF THE RESIDENC� IS REMOD�LED TO INCLUDE: MORE THFIN ] GEDROOMS SIGNED - y/(iyPL1[MNV) JHRES F SCHEFERS ISSUED B ~~�DHTE 0 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST ' 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED:— LEEGAL DESCRIPTION: D f 7M SLOPE SITE PLAN 3 4 5 6 7 8 9 Q/7111) I 10 VV 11 WAS GROUND WATER !7` S ENCOUNTERED? �`- ''(`S L O 12 P IF YES, AT WHAT E 13 DEPTH? - 14 COMMENTS PERFORMED BY: 72-008 (6/79) Reading Date Gross Time Net Time Depth to Water Net Drop " PERCOLATION RATE__`—) _(minutes/inch) t' TEST RUN BETWEEN FT AND ��.� FT CERTIFIED BY: DATE: ! /' - 81 00Nn1 (=O iCT y Municipality of Anchorage Development Services Department ' Building Safety Division On -Site Water and Wastewater Program : 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _O/S— /7/ — y/ HAA# 650-51 Expiration Date: otO 1. GENERAL INFORMATION Complete legal description 6/ock- S, C -e -wen lctn ce S/ -1i Location (site address or directions) 6r 6 2! _74mar A&-c,7,ke Current Property owner(s) Bet rry Q 4in /y, Day phone' 3 Y6- 3 2 ,rg Mailing address Lending agency Mailing address Real Estate Agent Mailing Address y__6 2 / T..tino� AutnuQ. An two. A�l< 995--�� _A lot lcu GLS A- G. q . Day phone Fn. &iAe To 4n Gt.-ty 6,1&4AIef/Ban kt. w Day phone -7z7-9a e 2�ZS �G"Sf� ta./e lOa� /4�+tl.o.ot Arc 99So? Unless otherwise requested, HAA will be held by DSD for pickup. P l Lowe cal! R.of/oe e 7 Z > -9ose 2. NUMBER OF BEDROOMS: 3 wticn 144A 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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. Name of Firm F'IONM 71cAr71ccr t' St` Phone T V,5` /3.Ss' Address INS30 Ec`+O V -/f^_ �. Ak 92 -5 -le' Engineer's Printed Name '/rtoce0rr T-', 7120"L Date la i io / 2aaSOr At YI•.....IIIIIIIIII IIIIi ti A♦ V- ----------^..01.00 NI/Iy 5. DSD SIGNATURE P ,i THEODORE F. wooRe� • x4 Approved for 3 bedrooms. `? w,•••c%v%.� �` '';,.'off•• •• .. �dw4<e Disapproved. Conditional approval for bedrooms, with the following stipulations: AAA;fl.,nnf (:nm mPn}R 1 ON�n nAlil Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By. 14-t- Original Certificate Date: (R.r 01107) Municipality of Anchorage • �` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Legal Description: A. WELL DATA Well type P t HEALTH AUTHORITY APPROVAL CHECKLIST k S; Ge-poA /and S/D Parcel ID: 01 S- 171 njI If A. B, or C provide PWSID # - Well Log (YIN) Y Date completed 8/19451 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth -2i—ft. Cased to -23--ft. Casing height (above ground) 2 IV in. FROM WELL LOG Date of test 6 / 19 /.F / Static water level is- ft. Well production 2 S g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: mg./I. B. SEPTIC/HOLDING TANK DATA Nitrate 3.16 mg./I. AT INSPECTION 9/Z9 /as ft. ys t 9.13 -m - Other bacteria 6 colonies/100 ml. Date of sample: /27!01- Collected by: F(a fk� T�cl� Suo Tank Type/Material _S Tank size /volt gal. Number of Compartments Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping N. A. /J f." Pumper C. ABSORPTION FIELD DATA Date installed l CJ / 3 / OS- Cleanouts (YIN) Y High water alarm (YIN) _ N• �• Date installed 1PLJ149T Soil rating (g.p.d./ft2 or ftz/bdrm) O.B drAo( System type eo Length 5-3, ft. Width 2.'r 1 ft. Gravel below pipe 11r.49 ft. Total depth r f—'/ ft. Eff. absorption area 7247 fe Monitoring tube Y Depression over field N Date of adequacy test N• A• C N#w) Results (Pass/Fail) PPL�/ For 3 bedrooms Fluid depth in absorption field before test O in. Water added o gal. New depth O in. Elapsed Time: Q_ min. Final fluid depth _Q in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Absorption rate >_ J/S'O g.p.d. If yes, give date N• A. D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Size in gallons Manhole/Access (Y/N) 'Pump off" level at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot to 2' Absorption field on lot Public sewer main N. A• Sewer /septic service line > 2S' On adjacent lots > l00 t 'M On adjacent lots 86 Public sewer manhole/cleanout N. A. Holding tank N• A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 19 ' Property line 0 f Absorption field Water main IJ - A. Water service tine > !!S' Surface water > tt+1o' Wells on adjacent lots > 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 27 ' Building foundation 16 , Water main N• A. Water Service line > 10' Surface water > 1000' Driveway, parking/vehicle storage > 2 s" Curtain drain Nese -Caen Wells on adjacent lots > 100 ' F. COMMENTSe 7-4e Ce/7c(rQA&" 0=441nee w0twe .ttue�e 31'"7/9Z ►Yfeeenc•,( /tarno dv ce f B9' r^_rbea iC of &&L hG w¢✓[ r nof^m-9 L otAAerrnf -44 . e..4.. J-@,— e..w.n J & t & r tie r- ewim tJ1 s. i{_ Imo. _;A .rho,r(a reMQrn vollto( ,Aare &%e Co✓retM� ece G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 7-Apwac, re F Flop ei' Date to/la / 200.- HAA Fee S `/ 30 Date of Payment (V(116 Receipt Number5��gv��_ (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number r:, i!CyTN w �� ' :ra.OJCRF F. wCORE �• �� 'fit e. .-. �.' •'J• Mimicipality of Anchorage ; 1'(). Box 19CAZA) • Mchomgc, Maska 981,519.666) • Telephone (9(17) 33..0,9101 •1'ax 3700 llmpw Stmet • Anchant9c, Alaskk SY.R)7 s • + xUIc.mmtl.oq( Mayor Mark Begich I3uilding Safety Divislon October 13, 2005 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AIS 99577 Subject: Waiver Request for Greenland Block 5 Lot 8 Waiver Request WR#: 050089 Parcel ID # 015-17141 PERMIT # SW050363 Dear Ted Aioore, P.E.: Your request for a waiver of the required 10 feet horizontal separation from the septic tank to the property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing septic tank 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 343-7904. Sincerely, OJroe(;oodall Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity m' Mayor Mark Begich DZunicipaht,3r of Anchorage P0. 1k).% 100(:50 • .4�chomgc,.11uski 9.O510d'di0 • Tcicphone (W7) 43 3.301 •1'nx (!M)7) a4A 1tM10 4700 lingrow• Strcct • Ajmhomge, Mask 91x,07 October 13, 2005 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AK 99577 mvv munl.org Building Safety Division Subject: Waiver Request for Greenland Block 5 Lot 8 Waiver Request WR#: 920012 Parcel ID # 015-17141 Dear Ted Moore, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the Talus West Block 4 Lot 3 septic system to the On -Lot private well has been approved. The approved separation distance is 88.0 feet. This waiver letter is issued to correct the approved measured distance, On-site Services letter dated March 17'", 1982. This waiver approval applies to the existing septic system to private well 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 343-7904. Sincerely, oY c Goodall Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity -4% MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _ Tot 8,_3j.oIt GLand S3;bd.,�_�o, 22, T 2, R3W Location (address or directions) (b) Applicant Name _ Jim SChefers_ _ Telephone: Home 346-3565_ Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); —_ (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Action Properties -- rkongkar KhaJ_Sa (Agent) Address _4450 Cordova, Suite 100, Anchorage, AK 99503 Telephone 5614060 (f) Mail the HAA to the following address. 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms _ 3 3. WATER SUPPLY Individual Well N Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite El 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. Page 1 of 2 72-025 nvoa� 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION R 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 bedroorns 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—QUADRA Engineering, :Inc. Telephone 276-3770 Address 401 East Fireweed Lane Date Engineer's Seal .A eso �. a.000ee o 0000 °� ,°�° Michaol E, l�ndvesv:eNJ 4381 ^ F 4 s ° ROFESS\fa AV DHEP APPROVAL L W__ Approvedfor / L �- -- bedrooms ' r -� Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 APR IynJ 264-4720 C E ((P Legal Description: Lot 8, Fffipp ► C I V E D Greenland Subdivision A. WELL DATA Well Classification Private If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present (Y/N) Y Date Completed _ 8119/81 Yield 2 5 GPM Total Depth 93' — Cased to 93' Depth of Grouting None Static Water Level 44' 3" Pump Set At _46'+ Casing Height Above Ground 22" Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 101 . 5' _ ; On Adjoining Lots 7 .`i0' + To Nearest Edge of Absorption Field on Lot __110 , On Adjoining Lots To Nearest Public Sewer Line _I M] + To Nearest Public Sewer Cleanout/Manhole _ 1 mt • i' To Nearest Sewer Service Line on Lot 92 Water Sample Collected by _ McFadden ; Date _ 3/16/85 Water Sample Test Results Comments Well is more than adequate for existing daily demand. B. SEPTIC/HOLDING TANK DATA Date Installed 1982 _ Size 1000 G No. of Compartments Standpipes (Y/N) Y Air -tight Caps (YIN) - X Foundation Cleanout (Y/N) y Depression over Tank (Y/N) N Date Last Pumped 3/14/85 Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) N/A 0 for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well _ 101 .5To Building Foundation 20 N/A To Property Line _ 2 7 ' To Disposal Field 71 To Water Main/Service Line _ 36' To Stream, Pond, Lake, or Major Drainage Course _None in area. Comments Page 1 of 2 c 00 79_n9r111 /RAI C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 250 sq. ft. Type of System Design — Date Installed 1982 Length of Field 82' Width of Field 30H Depth of Field 72 11 Gravel Bed Thickness 6' (according to installer) Square Feet of Absorption Area 205 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 3 / 16 / 8 5 Results of Last Adequacy Test Passed. Separation Distance from Absorption Field: To Water -Supply Well 110' To Property Line 12' To Building Foundation 25' To Existing or Abandoned System on Lot None. ; On Adjoining Lots 1001+ To Water Main/Service Line 55 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course None in area. To Driveway, Parking Area, or Vehicle Storage Area 2 5 ' Comments Absorption field is adequate. trench D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certifythat I jhave checked,e(ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed "', Et4tz&��Date March 18, 1985 Company OUADRA Engrng. MOA No. ST 85-199 Receipt No Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Qaf�-A�80 00 or 03 d'_ a6D 0 •ee0�ai•B®O�BO CY@goo**elssaw ®eaea a<aeo •oep 1.aeeso�s•w Q® �M Michael E. Anderson �% 4381-E ^:•�� pROFESSIONP�gw��� Engineer's Seal CJ , T - Time APPLIC NT PILLS OUT UPPER HAL ONLY Property Owcsr _� �, Time Date Phone Date Date _ Mailing Address"i 'Lip Code Buyer Inspector Inspector Inspector Address Zip Code Lending Institution �'.r , _ .- ! ` _- -_ f,. `j ,' (' > f -, Phone Address �`:,. -, =-o. k r1 r ,:. '.. s FT r - < p. ,:, Zip Code _ Realty Co. & Agent �� Phone DEPT. OF H`_ALTH "t Address Zip Code Legal Description Street Location I&, Type of Residence RECEIVED Single Family _ 'CONDITIONS ❑'Multiple Family No. of Bedroorns j ❑ Other ( ) COONNDITIOt/SAL APPR VAL' / �_ , ' Water Supply —_ Individual BY: ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. O Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Well To Absorption Area ] Sewer Disposal Individual Year Individual Installed: ❑ Public Utility Well to Tank When Connected to Public Utility: z'4 -- ❑ Holding Tank Septic Tank Size NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. CJ , T - Time Time Time Time Date Date Date Date _ Inspector Inspector Inspector Inspector Field Notes:—— _ MUNICIPALITY OF ANCHORAGE �� DEPT. OF H`_ALTH "t ENVIRONMENTAL PROTECTION J01- 11.. 6 1963 RECEIVED (,3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) COONNDITIOt/SAL APPR VAL' / �_ , ' DATE _ ; — IV Z —_ BY: Soils Rating Date Sewer Installed Well To Absorption Area ] Well Log Received Well to Tank Septic Tank Size 72 023 (WK)