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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
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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
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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)