HomeMy WebLinkAboutGREENLAND BLK 6 LT 5Greenland
Block 6
Lot 5
#015-171-20
Municipality of Anchorage
S
Development Services Department -
Building Safety Division
- On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 995136650 Page I of ?J
www.d.onclwrage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO50148 PID Number. 015-171-20
Nem. E.F. McClure
Wastewater System: ❑ New ❑ Upgrade
A4dn. 4620 E. 113th Ave., Anchorage
ABSORPTION FIELD
PhGn4, NvnE gaednoma 3
ODepTtamh EIShebn Tench❑Bed ❑Mand ❑other
Sol Ramp
Tgal DepthItorr, 0-gMl ands
LEGAL DESCRIPTION
6.0 GPDIFIt
+1.0 above OG Ft.
ncn:
Bbck Lot 5 sade
Greenland
Depth b ppe i,teim ham apnal ands
+1.5 OG
Gid depin baneathpp.
0.5 Ft
6
above Ft.
Ta~q, Range secOon
FA added Ob" a9ne1 ands
Gr" Length.
15.0
2.5 Ft,
Ft.
Well: ❑ New ❑ Upgrade
r„eyq t.,,d,n
5.0
Numbarq enet:
1
Debra DeMeankw
NA Ft
Ft.
Gbaalcaoon (Pm•'w. A B. GI
Tata DOM
bred b
Taal aborp0pn area
75
Poo Mateal
ASTM D3034
Ft.
Ft
Ft'
w Arc /Y
Cl1QQ
D. Dnp
S Water �q
mblw: A+ Home Services
o�etnmbd 6/14105
Ft
yed p.�pSetn
bangH.ghtAo G=od
TANK
GPM FL
Ft
i1
SEPARATION DISTANCES
❑septic ❑Holding ❑S.T.E.P. El other:
To
Septic
Absorption
Lift
Holding
ubaNPrkate
as '.`
Anchorage Tank & Welding
1500
50 Gal
F om
Tank
Field
Station
Tank
Sewer Line
102
120+
114
NA
60
MatenaL
3116" steel AdvanTex tank
Nunea q Gonparnmenb
2
wet
smd.watat
100+
100+
100+
NA
LIFT STATION
5e
35
NA
a 100 Gat
mine Anchorage Tank &Welding
Lot LM
40
'Pony ori beq at
-Pump dr level N
h ta FM al
Mpwe
Fcondatcn
25+
50+
35+
NA
32 M
22 in
to
Perry Mahe a Mmdsl
Ebarol Intpeclnns psdormed by
Curtain Dram
NA
NA
NA
NA
OSI20
Michael Green/MOA
Rennedte 1995 bed reduced in size & retained. "Lot line
BENCH MARK
waiver approved for 1995 bed.
Joatan w Daw�poon
Top of Pump Vault
rred e+atum
99.22 Ft
E '
gtrF•.... ....!9� _
P• ,IkP
9TH
*° 4 9
Inspections performed by: Cindy W. Ellis, P.E. Dates: 1°t 6/13/05
2n° 6/14/05
� `•. Ci W. Ellis
Development Services Department: Approval
Y
CE -10577
Reviewed and approved by: / Date: G�4Z 7 O
••...,,•„•,...••���
ota til
�ESslorYa�//
_EAST JJ 31K -AVENUE
a
K
2
P�
1 4P
MT1
S 89049'21"E 1
SINGLE FAMILY
FRAMEHOUSE
DECK
1IDO0
Vault
MT5
-----ALLEY -------
AS -BUILT
Greenland S/D, Blk 6, Lot 5
Record Drawing of Septic Upgrade o .
QF gtq`:t,,
EF. McClure Watkins Engineering, Inc.•'..•s� I;
Parcel ID: 015-171-20 0° ' 49 T—H T'
Permit No. SW050148
G.....?,
Cindy W. Ellis, P.E. P.O. Box 110443 Cho: clr w0E771s
June 16 2005 Anchorage, Alaska 99511-0443 �0�.,'' •... ..•
Scale 1 Inch = 30 ft
Phone: (907) 349-1851, Fax (907) 349-1934 �,`.e;,.....•.���'
`r c�G
A
B
STI
44.8
37.1
MH
52.4
40.4
PV
57.9
41.7
MT1
71.6
83.7
MT2
86.0
95.0
MT3
75.0
62.4
MT4
86.9
72.5
MT5
89.7
59.5
AS -BUILT
Greenland S/D, Blk 6, Lot 5
Record Drawing of Septic Upgrade o .
QF gtq`:t,,
EF. McClure Watkins Engineering, Inc.•'..•s� I;
Parcel ID: 015-171-20 0° ' 49 T—H T'
Permit No. SW050148
G.....?,
Cindy W. Ellis, P.E. P.O. Box 110443 Cho: clr w0E771s
June 16 2005 Anchorage, Alaska 99511-0443 �0�.,'' •... ..•
Scale 1 Inch = 30 ft
Phone: (907) 349-1851, Fax (907) 349-1934 �,`.e;,.....•.���'
`r c�G
FCO
94.18
93.53
1.25"0 PIPE
101.05
inal Grade 100.03
Top of pipe in
1995 bed = 98.03
AS -BUILT
SEPTIC SECTION
N.T.S.
FINAL GRADE
ST'
98.59'
99.06 99.03 99.22
:z �2..".. To Old
ADVANTEX MAN- PUMP Drainfield
AX -20 POD ' HOLE VAULT ,,,,,,,,,,e _;, e
To New
Drainfield
STEEL ADVANTEX TANK (red pipe)
1500 GALLON
MOUND MT5
FINAL GRADE = 104.15'
FILTER FABRIC & INSULATION 101.65 3:1 scope
T7\
on sides
of mound
SEWER ROCK
LEVELING SAND
LENGTH
15.01
,�— 7—! Bottom of Excavation
95.83 -96.03
1
Relative Depth of Water
in Test Hole = 94.03
Impermeable layer @95.03'
Greenland Blk 6, Lot 5
Record Drawin of Septic Upgradeatkins
Engineering, Inc.nC
5- OFAt'
�'' _�` .,
EF. McClure
49IHI y,it
Parcel ID; 015-171-20
` '" ' l
Permit No. SW050148
C ; '•, CI V W. ELLIS j
�•; •.• E - 10577 •:
u��.• •..• ; :'
Cindy W. Ellis, RE P.O. Box 110443
June 16, 2005
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax: (907) 349 -1934
a.•. .�--
�,mss-
No Scale
�.... �..rw,na�. •ra. 807 272 4690. os/16/0E 0911
2pm P. 001
From +19079703507 wed Jun is o5:22;01 Zoos
Pw•1oP1
OM,ns.11:Y IAZScaML
�-'oOrm
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
4700 SOUTH BRAGAW
INSPECTION INFORMATION &HELP: 343-7962
INSPECTION: VOICE 343-63M INSPECTION: FAX (907)249-7777 www munLor /ESDlIms
_ 9 peeUorse.cfm
NAME edseleu PERMIT#: 05-3264
COMPANY INSPECT DATE: G/i mzws PM
PHONE/ PHONE P
PHONE M
ADDRESS
4320 E 113TH AVE
LOT aBLOCK e SUBDIVISION GREENLAND GRID& Swma
COMMENTS or DIRECTIONS
SE#'rlc— LrFT,
TYPE OF INSPECTION: Retro Elealrloal REINSPECTION: YEI; NO
COMMENTS: (FOR INSPECTOR USE ONLY)
SE('T1C, L(Fr ��Tc� i to1�1 t=LEC T(Zlc,c�(— FIN•L
PRINTED NAME C Nil (, DATE:
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d 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: SW050148
Legal Description: GREENLAND BLK 6 LT 5
Design Engineer: 0844 Watkins Engineering, Inc
Owner Name: E.F. MCCLURE
Owner Address: 4620 E 113TH AVENUE
ANCHORAGE. AK 99516-1619
Date Issued: May 31, 2005
Expiration Date: May 31, 2006
Parcel ID: 015-171-20
Site Address: 004620 113TH AVE E
Lot Size: 18000 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
M Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling
(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, sealed, and heated to prevent freezing.
5. The following special provisions.
-THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST
BE VEGETATED SUFFICIENTLY TO PREVENT EROSION.
-CONSTRUCTION TECHNIQUES NEED TO BE USED TO GIVE SAND AND GRAVEL ABOVE GRADE
STRUCTURE AND SUBMITTED WITH AS -BUILT INSPECTION REPORT.
-ANY EXCAVATED CONTAMINATED MATERIAL NEEDS TO BE PROPERLY DISPOSED BY THE DIRECTION OF
THE DESIGNING ENGINEER.
Received By.
Date:
Issued By. Date:
6-1-05
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.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-171-20 Permit Number SW
Property owner(s) E.F. McClure Day phone
Mailing address (1) 4620 E. 113th Ave.
Mailing address (2) Anchorage, AK Zip Code 99516
Legal description (Lot, Block & Sub'd.) Greenland SID, Blk 6, Lot 5
Legal description (Section, Township & Range)
Lot Size 18,000 Acre q.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms 3
ZD
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade El
THIS PROPERTY CONTAINS:
Hot Tub 13 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.
(Signature of prop(rty owner or authorized agent)
Permit Fees: A Lit .CX:� Waiver Fees:
Date of Payment: qjp/Ns Date of Payment:
Receipt Number. (o ZL n _ lA(Y\ Receipt Number:
(Rev. 12100)
Watkins Engineering, Inc.
RO Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis@gci.net
May 23, 2005
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Greenland S/D, Block 6, Lot 5
Septic System Upgrade
To Whom It May Concern:
Attached please find the application and supporting documentation to upgrade the
septic system for the referenced 3 bedroom home. The existing drainfield was installed
in 1995 and is surcharged. The initial septic system was installed in 1971 and upgraded
in 1977 and 1995. The 1971 and 1977 systems were abandoned in 1995, because they
were in groundwater. Due to the minimal remaining space on this 18,000 sq. ft lot, and
the high groundwater, an advanced onsite wastewater treatment system is proposed.
The existing bed will be shortened and retained for future use. It is proposed to
excavate a portion of the bed and construct a new 5 -wide trench. This property is being
sold, and the MOA maintenance agreement will be signed by the buyer at closing.
The proposed design is based upon a test hole dug on April 29, 2005. There was an
impermeable silt layer encountered at 5 ft. No groundwater was encountered when the
hole was dug, but it was measured at 6 ft below grade after 7 days of monitoring. To
obtain a 6 ft separation to an impermeable layer, the drainfield will be mounded, with the
bottom of the sewer rock 1.0 ft above original grade. All contaminated material from the
old bed will be removed and clean sand will be used to backfill and to elevate the bed to
1 ft above original grade. The native sand in the test hole from 2 ft to 5 ft had a
percolation rate of 1 minute per inch. An application rate of 6.0 gpd/ft2 is used in the
design. The soil log is attached.
Proposed Soil Absorption System:
3 Bedrooms x 150 GPD/BR = 450 GPD
System Type: AdvanTex w/5 -wide
Application rate: 6.0 gpd/ ftZ
450 GPD / 6.0 gpd/ft2 = 75 ft' required
Sewer Upgrade Permit Application for Greenland Blk 6 Lot 5
Watkins Engineering, Inc.; May 23, 2005; page 2
Proposed Soil Absorption System (continued):
Effective Depth:
Dimensions:
Bottom of sewer rock:
0.5 ft
5ftx15ft=75ft=
1 ft above original grade
All of the contaminated material from the old bed will be excavated and filled with clean
sand to 1 ft above original grade. An impermeable material will be placed between the
old bed and the new trench. The distribution pipes in the old bed will be shortened and
new monitoring tubes installed. The distribution pipe in the trench will be 3.5 ft higher
than that in the old bed, due to differences in design. No impermeable layer was found
in the 1995 test hole evaluated by S&S Engineering.
There are no surface waters or private wells within 100 ft of the proposed septic system.
am not aware of any adverse effect that this upgrade would have on any adjacent
properties' water and wastewater treatment needs.
Thank you for consideration of this permit application. If you have any questions or
need further information, please call me at 349-1851.
Yours truly,
CindyEllis, P.E.
President
II I VgELL VELLI
\ I
Exis ing Septic System. e
Cn n
I Ln 99
m
I�
Io-
II
Imm
r
East 113th Ave.
---------------
�i I
WI
\ 4
THLo:P�rop.
_
sedSt
ea n
20' Nl[T
�
1
�G OF q '-
OFA
Proposed Septic Upgrade -Site Plan
ri h
�G OF q '-
OFA
Proposed Septic Upgrade -Site Plan
Watkins Engineering, Inc.
t j
^
�,��''.........0 yst: ;.,.
'
EE Mc Clure
9
10
11
12
�
h
P.O. Box 110443
\
May 23, 2005
Anchorage, AK 99511-0443
IWEL�
WELL
Phone: (907) 349-1851 Fax: (907) 349-1934
.........
v�p�a'
e WELL
East 115th Ave
Greenland S/D, Blk 6 Lot 5
�G OF q '-
OFA
Proposed Septic Upgrade -Site Plan
Watkins Engineering, Inc.
t j
^
�,��''.........0 yst: ;.,.
'
EE Mc Clure
�P'� 'f
TH
q - �,
Parcel ID: 015-171-20
A : J.49
Cindy W. Ellis, RE
P.O. Box 110443
` ar�y w0577IS f•
cA• I {D LLIS ......,''
May 23, 2005
Anchorage, AK 99511-0443
v-,
va -
Scale 1' - 100'
Phone: (907) 349-1851 Fax: (907) 349-1934
.........
v�p�a'
a
��5� O
Lot 6
0
W
DESIGN DETAILS
3 BR, 450 GPD
6.0 gpd/ft2
Requires 75 ft2
5 -Wide Trench
0.5 ft effective
15 ft long
75 ft2
Mounded
WELL (((��� I Proaerty Line is
27.5i�goRh
/ � 1
I
/ 3 SR House
0
0
m 1250 gal STEP to
to be abandoned.
W /
0
o /
p bZF.�
O �rhis 1lne to be
Z abandoned
&9COQ_
l
fence
1971 se
977 trench,
b I Lot 4
0
co
o I
I
o /
r`
0
o/
/ Lot 4 well
\ 100ft radius
Extent of
Mound \
x
AdvanTex w/dual outlet
pump vault to be installed.
Excalvate all contaminated
mates al in old bed. Assume
2 ft do each side and 2 It
on bottom. (26 It x 17 ft)
-9dic<fill with clean sand.
Proposed drainfield: 5 -wide,
0.5 ft effective, 15 It long
Pipe to be 3.5 It higher than
Cut distribution / Impermeable Install3 MTs
pipes in old bed. material (10)
between old
and new
drain(elds
TH
+1.0
OG
Organics
Pipe In
Redoam
192u,
Watery -2.0
-6.0 on Sand
5-9-05
-5.
Imper-
meable
Silt -9.0
BOH
Greenland S/D, Blk 6 Lot 5
Proposed Septic Upgrade - Site Plan Watkins Engineering, Inc
EF. Mc Clure
Parcel ID: 015-171-20
Cindy W. Ellis, P.E. P.O. Box 110443
May 23, 2005 Anchorage, Alaska 99511-0443
Scale 1 inch = 30 ft Phone: (907) 349-1851, Fax: (907) 349-1934
Proposed
5' wide
Trench soil cover -
+4.0seeded
iO.5'sewer
abric & insulation
12.01.5 -PVC w/0.25"
holes,18.00
rock
:�- clean sand
Previous
contaminated
material
NTS
?...WlU.LLIS
41 1;v
- 16577
�. ;
Municipality of Anchorage
Development Services Department
Building Safety Division
+e,t On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Boz 196650 Anchorage, AK 99519-6650
www.munl.org/onsile
(907)343.7904
Soils Log - Percolation Test
Performed For. E.F. McClure
Legal Description: Greenland Blk 6 Lot 5
Depth
'I Organics
ML I Pe Ua wt -
R
5-1 5.0
6- I mext-tvteable
7- ML 54It
Date Performed: 4/29/05
Township, Range, Section:
16-
17-
18-
19-
20 -
rian
Reading
Date
WAS GROUNDWATER
9
Depth to Water
_I . D ENCOUNTERED? NO
1-2
2
6o
S
10-
6-0
IFYES,ATWMATDEPTH? — L
11-
Depth to Water After D
to. C) P
10
6-0
Monitoring? E
12-
Date: 5 -9 -CIS
13-
6-0
6
16-
17-
18-
19-
20 -
rian
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1-2
4/30/05
8:29-8:39
10
6-0
6
34
8:40-8:50
10
6-0
6
5.6
8:51-9:01
10
6-0
6
7-8
9:02-9:12
10
1 6-0
6
9-10
9:13-9:23
10
6-0
6
11-12
9:24-9:34
10
6-0
6
rcKc;cng11UNKATE r (mae./mch) PERO HOLE DIAMETER e
TEST RUN BETWEEN 3.0 FT AND 3.5 FT
COMMENTS Sal vAl serve es a nalural sand Nter. Sat from 5 to 8 "a Irnpemreable.
PERFORMED BY: Watkins Engineering, Inc. I (/i�ktC 4V L't.<✓ CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDE ES IN EFFECT ON THIS DATE. DATE: S --/p -
FMunicipality of Anchorage Page l of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: '5w 95 031 PID Number: 0l5 ( If -.o
Name:
IJANcI C��•rcHE;sc.
Wastewater System: ❑ New � Upgrade
Y pg
Address:�S1 „� "� \%AL_t=', OR. 97418
ABSORPTION FIELD
Phone _
('� �3) 4/ -7 3 — a 9y�
Noof Bedrooms:
. 3
❑Deep Trench ❑Shallow Trench 0 Bed ❑Mound 11 Other
LEGAL DESCRIPTION
Soil Rating:
O.9
Total Depth from original grade:
t
GPD/Sq.Ft.
a.5
Lot: Block: Subdivision:
49
Depth to pipe bottom from original grade:
I
Gravel depth beneath pipe
t
15 %R,�,E77GAN D
a Ft.
0.13 Ft.
Township:
Range
Section:
Fill added above original grade:
Gravel length: /
WELL: New ❑ Upgrade
Gravel width:Number
l's,
of lines:
3
Distance between lines:
1 `I•s
xlsr/N�❑
Ft.
FL
Classification (Private, A,B,C): Total Depth:
Cased
Total absorption area:
Pipe material: ASTv^A
--P(ZIv/AT`I t.
Ft.
IILl0 SO. Ft.
-DS 03`d/F&10
Driller:ate Drilled:
Static Water Level:
Installer:
Date installed:
(O-II-��
Ft
TU>EZC� Cxc,
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding 9 S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
A eA C7L5___rA to
Capacity in gallons: 10570
From
Tank
Field
Station
Tank
Sewer Lines
ty< Ho
Well-In
t I
1
las
I
IoI
,
as +-
Material: STEI^L
_
Number of Compartments:
Surfac
Watere
(00I 4-
100!4-
Ino,-
LIFT STATION
Lot
Line
t
-53
r
I
53
Size in gallons:
IQ 5,?-;,
I Manufacturer:
fl/J�Np2/+vcs %aaK
Foundation
a (�
5 I
--
,�
"Pu on" level at:
"Pumpoff'level at
High W alarm at
CurtainC
K
Ufs-�N
Pump Make & Model
Electrical Inspections performed by: 1
%'1 V
Drain
os/ oSf#N
• -
Remarks:
BENCH MARK
Lip, t5000097
Location and Description:
-Tb ? rpt:
U 1= 40 v1$ZF
v
Assumed Elevation:
Ioo,O
Enfl�?
rj to 'CYT
S & 5 ENGINEERING
��EalRlver60o Road No.
Inspections perform42y- Dates:lst
River,
^ - •-• . � �
d"" , « .. �..............: ......r
I.
ase
2nd l U I I-
ROBERT C. COWAN r
CE • 8801
V
Depof Health and Human Services approval
`-'"• .,,., `:`�`
,,.. ;;;
Reviewed and approved by: J2 Date:
72-013 (Rev. 9/91) MOA 25
Permit No. SW95031 9 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 o Anchorage, Alaska 99519-6650 e Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
LOT 5, BLOCK 6, GREENLAND S/D PID No.: 01517120
_
72-073 A (Rev. 9/97) MOA 25
M1111
M
2
ST1 ST2
99.3'FI
AL GRADE
M
I
100.2'/
-FINAL GRADE
INSULATION----,
NEW---
°
98.2'-/
93 8'
1250 GAL
S.T.E.P.
�
SYSTEM
dMT3
97.7'
MT2
\
♦ 92.7' WATER
POUND
9--6-9
LOT 5
A
FCO
--
11'
WELL
ST1
31'
4'
�j
ST2
32'
0'
SHED
MT1
84'
2'
MT2
96'
7'
EXISTING
3 f
NCE
MT3
58'
0'
BEDROOM
MT4
69'
9'
HO
SE
Yv
X
FENCC X—
X
F
0
�O
ti
A
cD,
N E
1
50 GAL
° STI
u�)�P*N'Ak�-`
EXISTING
ABANDONE
ZST2
1H f �p1H. bH[::HHrn�
ROBERT C. COWAN e
1+ I
C , CE -88
st'�'^�...
SCALE 1" = 40'
NEW BEI)
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PAGE 1 OF 1
") ocY�
MUNICIPALITY OF ANCHORAGE i
DEPARTMENT OF HEALTH AND HUMAN SERVICES 0
P.O. BOX 196650, 825 "L" STREET, ROOM 502 ILAPc(\
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950319
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:GETCHELL JAMES H &
OWNER ADDRESS:4620 E 113TH AVE
ANCHORAGE, AK 99516
PARCEL ID:01517120
LEGAL DESCRIPTION:
GREENLAND BLK 6 LT 5
LOT SIZE: 18000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED:10/05/95
EXPIRATION DATE:10/05/96
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE: / 0 /6/ 41
DATE:
Mtmieipahty ®f Anehorage
Department of Health and Human Services
825 1" Street
Rick Mystrom,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
October 6, 1995
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 5 Block 6 Greenland Subdivision
Waiver Request #WR95000047, PTD #015-171-20, SW950319
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 1 foot to the south property line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Obert W. Robinson
Civil Engineer
On-site Services
RWR/ljm#7
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR950047 PID# 015-171--20 HA# Permit #
Date Received: September 18, 1995
Legal Description: Lot 5 Block 6 Greenland Subdivision
Engineer: Robert C. Cowan, P.E., S & S Engineering
17034 Eagle River Loop Road, Suite 2.04, Eagle River, AK 99577
Applicant: Jim/Nancy Getchell
Waiver Requested: lot line waiver of 1 foot to the south property line
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation'
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: _ / Waiver is NOT Granted: _
List Conditions or Reasons for above:
Date: �By:
Name of Reviewer
Rec if: #01307/3068 Amount: $115.00Date Paid: 9-7.8-95
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
S&S
1nG
September 13, 1995
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 5, Block 6, Greenland SID
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
Request you issue a permit to upgrade the septic system
serving the three bedroom housp on the referenced property.
IJL50 RErd✓cST I' W.9,VC,e TO Lu�LNC TO rklE SOv.N. /4JJ4CF,,, A0'492ry
1445 vr,L,ry RL,,,..L 7-H,S p4o,�e try L,'vj A,,I) 41 J✓cH we✓4e HAd6 NO i1 l)✓i.2tE
A test hole was excavated and a percolation test performed a>?gdcr1,
in the area of the proposed upgrade. The approximate
location of the test hole is located on the attached site
plan.
At the time of excavation water was encountered at eight
feet in the test hole and after seven day ground water
monitoring, water was found at seven and one half feet.
Attached is the proposed upgrade design.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
?4�4 .
Robert C.
RCC/gk
Enclosure
�L
Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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AN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG •-- PERCOLATION TEST
PERFORMED FOR: J(fli 4 Ngrc-y arLTc.14CLC
v0 SID
LEGAL DESCRIPTION: I -o-1 S 13i -t<` G2EtN� Township, Ran
DEPTH SLOPE
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14-
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TEST RUN BETWEEN _ FT AND FT
COMMENTS b ver Q Y ri✓/L 10 g X -
PERFORMED BY: �.� � ( � CERTIFY THAT THIS T/�ST WAS PERFORMED IN
ACCORDANCE WIT11� �^ IN EFFECT ON THIS DATE. DATE: ! l ( 4
72-008 (Rev. 4185) Eagle River, Alaska 99577
e Municipality of Anchorage7.
F,
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 „• .;. <:j<,:,/�<.,,::,...
+LAG:
SOILS LOG -- PERCOLATION TEST
I' ;a R07EP.T C. COWAN
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PERFORMED FOR: J I rL N41, c- Y
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- DATE PERFORMED: �"
LEGAL DESCRIPTION:'t'� 7 13Ld{ ` G2C• NLA Township, Range, Section.
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ENCOUNTERED?
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IF YES, AT WHAT L
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DEPTH? P
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Depth to Water After
Monitoring? Date: cl q fy
A
Reading Date
Gross
Time
Net Depth to Net
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A 0- +K
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PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
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COMMENTS by( (3 Y rW Pe, r 0 9 k.
PERFORMED BY: I CERTIFY THAT THIS T/QST WAS PERFORMED IN
ACCORDANCE WITI ��� �#�_fg4�i�Qft�tlg�lp IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85) Eagle River, Alaska 99577
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PIANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL?
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
S&S
inq
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS
79
CONSTRUCTION PRACTICES FAX(694-29AX (907) 694-4-
1211
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 5, Block 6, Greenland S/D
September 13, 1995
IGENERAL:
1. The scope of this project includes the installation of
a 1250 gallon wastewater S.T.E.P. system (septic tank)
and two five wide pressurized leachfield trenches to
serve the three bedroom residence located on the
referenced property.The existing 1000 gallon septic
tank is to be excavated, pumped, crushed, and
abandoned in place. The existing leachfield is to be
abandoned in place.
2. Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
IC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified
septic tank manufacturer.. Construction shall include
two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to
prevent settling or shifting of the -tank.
3. All standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page Two
Lot 5, Block 6, Greenland S/D
September 13, 1995
4. Septic tanks installed with less than 4 ft. of cover shall
be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfi_eld there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCIi/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before
gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the holes faced downward. The
distribution piping is to be of PVC (ASTM D3034 or equal).
All joints are to be solvent cemented. Gravel is then to
be placed over the distribution pipe to provide a minimum
of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 5, Block 6, Greenland S/D
September 13, 1995
5. Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty --six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast
Iron
Yes
Yes
ASTM
D3034
(PVC)
Yes
Yes
ASTM
F810
(HDPE)
Yes
No
ASTM
D2662
(ABS)
Yes
Yes
Use of a type of pipe other than listed above must be
approved by -the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mi.rafi 140N,
or equal) must be installed between the final leachfield
grave]_ layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #7.00 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 5, Block 6, Greenland S/B
September 13, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final. inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 5, Block 6, Greenland SID
September 1.3, 1995
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
MA I ER ANCHORAGE AREA BOR�>;JGH
Department of Environmental Quality
_ 3330 C Street
t Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISP_OS L SYSTEM
NAME1'-`" l _C��«-M-R[LING ADDRES�,�PHOII� fL.
LOCATION //6(k LEGAL DESCRIPTION
i
L
SEPTIC TANK:
DISTANCE ` NUMBER OF
FROM WELE( _'Sj6 MANUFACTURER _ MATERIAL COMPARTMENTS
INSIDE LENGTHI INSIDE WIDTH LIQUID DEPTH __ LIQUID CAPACITY GALLONS.
TILE DRAIN FIELD:
.{-� ;// '-2 U TOTAL LENGTH (�
DISTANCE FROM WELL X- W / �O 1NDATION 5 _NEAREST LOT LINE_ OF LINES 7 A
NUMBER OF LINES(�_, DISTANCE BETWEEN LINES -TRENCH WIDTH_ IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE_
DEPTH OF FILTER
DEPTH_ TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE-_ IN. ABOVE TILE IN.
WELL:
TYPE CONSTRUCTION _DEPTH ___ DISTANCE FROM:
BUILDING NEAREST
FOUNDATION, LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:
SE=WER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form EQ -039
NEAREST SEPTIC SEEPAGE
SEWER LINE , TANK , SYSTEM_
REMARKS
DIAGRAM OF SYSTEM
5 le'D e-.
f /E D
4
c;o
r iEF �E E f�1f�
DATE _/1 !-('A-rROVED t(--�-�--y
/ - G.A.A.B.
�
PEHMIT NO
�EPHRTMENT nF HEHLTH HND ENVlRONMENTHL pROTECTION
825 STREET, HNCHORHGE, HK� 0i
0
279-2511
����11 utof A(�
HPPLICHNT i 1 1:�T��_R8�,
|,GCFUION 116TH ST
LEGHL L5 B6 GREENLRND SUBD
2804 NORTHERN LIGHTS
[YPE OF SOIL HBSORBTION SYSTEM IS� TRENCH
'~x
LOT 5IZE / SQUHRE FEET
MHXIMUM NUMBER OF 8EDROOMS � ] SOIL RHTING (SQ FT/BK)� 275
THE REQUIRED SIZE OF THE SOIL H8SORPTION SYSTEM IS�
/
�
� ������ if
THE LENGTH DIMENSlON I� THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIEL0
THE DEPTH OF H TREBETWEENTHE SURFOCE DF THE
GROUND HN� THE BOTTOM OF THE EXCHVHTIUN (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
AND THE 2O7TO� OF THE EXCHVHTION (IN FEET)
����
11 :.v I -��� 1�pI
EITHER R CLHSS I OR II NSF HPPRUVED PLRNT MHY BE INSTHLLE�
H CONTINUOUS MRINTENH�CE HGREEMENT IS kEQUIREDIF A MHINTENHNCE
RGREEMENT lS NOT KEPT CURRENT YOU I8Y BE REQUIRED TO ENLHRGE THE SO(L
RBSORPTIOH SYSTEM HND/OR YOU MHY BE SUBJEC[ TO PRO5ECUTION
IF H CLHSS I SYSTEM IS USED THE LENGTH IS 490 FEET
lF H CLHSS II SYSTEM IS USED THE LENGTH IS 6I0 FEE[
If if if if��f 11 If if
BRCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION RID RPPROVHL BY THIS
DEPRRTM2NT WILL BE SUBJECT TO PROSECUTION
MINIMUM DISTRNCE BETWEEN R WELL HND HNY ON~SlTE SEWHGE DISPOSHL SYST�M I�
100 FEET FOR H PRIYHTE WELL OR 200 FEET FOR H PUBLIC WELL
SPECIFICRTIONS RND CONSTRUCTION DI8GRHMS HRE RVRlLHBLE TO I�SURE PROPER
INSTHLLHTION
�if 11 '1 �f If I i I�
LOCATION 4'
SEPTIC TA K:
r"CATER ANCHORAGE AREA BORE ' GH
HEALTH DEPARTMENT 1�Tp i 3
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 lV
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS
(/ P H O C
EGAL DESCRIPTION �� / �� A�/\ L4 GTS
DISTANCE FROM WELL- MATERIALEO
--COMPARTMENTS
C� r_f�
LIQUID CAPACITY' GALLONS. INSIDE LENGTH INSIDE WIDTH_
SEEPAGE SYSTEM:
SEEPAGE PIT:
NO
LIQUID
DEPTH_
NUMBER OF/PITS OUTSIDE DIAMETER OR WIDTH - LENGTH -��� DEPTH,
LINING MATERIAL.DISTANCE FROM WELL ,BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL , FOUNDATION , NEAREST LOT LINE
NUMBER OF 11 1ES DISTAN BETWEEN LIN TRENCH ID
ABSORB AREA SQ, FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
IN. TOT
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: DISTANCE FROM WATER
TYPE C'Tf e �i/ G DEPTH BUILDING FOUNDATION. SAMPLE , NEAREST
NEAREST SEPTICC�l� T SEEPAGE C OTHER
LOT LINE SEWER LINE TANK / 2 _, SYSTEM CESSPOOL SOURCES`
DIAGRAM OF SYSTEM
DISTANCES:
�fGv1
/iTm
C�
``Li
11
�e
,�
t Z
DATE
i
APPROVED
HEALTH AkUJfl0RllY
---
cAAn.an-L GREATF ANCHORAGE AREA OROUGH Case No. z�?
HEALTH DEPAItTMENT
327 Eagle St. Anchorage, Alaska 99501. 279.2511
SEWAGE: DISPOSAL SYSTEM e APPLICATION & PERMIT
NAME OF APPLICANT "z ��"� t MAILING ADDRESS -6 2 ��A _ s PHONE NO..,"
RESIDENCE ADDRESS e LO_!"� ���f9
CATION OF INSTALLATION
��
®LEGAL DESCRIPTION lorr ` 4t_4 % 'hu_alJ44W ��
APPLICATION TO INSTALL: SEPTIC TANK X SEEPAGE PIT )( , DRAIN FIELD- OTHER
TO SERVE THE FOLLOWING FACILITY_XkAt'yii6 XIV444C(
_'_
FINANCED THROUGH f )� _ TO BE INSTALLED BY Eocl`z �� _
PERCOLATION TEST RESULTSL� �'7 ANTICIPATED DATE OF COMPLETION�I�i
ss BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS �G` rc�� , PERMIT TO INSTALL A
,AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED — 'Z"�l��
w_
,SEPTIC TANK SIZE 1_� ' V ,TYPE ` .SEEPAGE AREA �Q3 TYPE
DIAGRAM OF SYSTEM /
DISTANCES:
/G mid vf'
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28,68 and that the
above described system is in accordance with said code. 1� l
. E
DATE - ��,vf �� APPLICANTS SIGNATURE � S!
'RE/1! M.
AMIn nof 1 .7 LN,
327 EAC![ a7RFQ CASE
AVCH0xAqy, AVO�A Qqso-j-
PcW"Med Yor Donald Dahl
Leys! bus, Ferfarmed
5/6171
This iorm Repovys Greenland
AMA
Deneb
Toll
brown and ray g
it silt (MLT xavelly
4-1 gray sandy silt (ML)
with gravelly sand and sil
6 4 sand 4' - 6.5'
8
10-
12
14 --
Was Ground WaTur
J
Leading Oato
-- ---------
T
me,
Dun in 420
Depth
COME17S.
CM Of Fit
Test Performed
..........
Data Certified Bv; National Testing
Services,
Inc.
DateMAY
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South 9ragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING
Parcel I.D. 015-171-20
1. GENERAL INFORMATION
Complete legal description Greenland Blk 6 Lot 5
HAA# 05021 0(p
Expiration Date: - J — �- 14 r D-6
Location (site address or directions) 4620 E. 113th Ave., Anchorage
Current Property owner(s) E.F. McClure
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
4620 E. 113th Ave., Anchorage, AK 99516
Paul Ames
Day phone
Day phone
Day phone 273-7730
3801 Centerpoint Dr., Suite 200, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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 seat 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 watersuppiy 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 Watkins Engineering, Inc.
Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis Date 6/20/05
rd
5. DSD SIGNATURE
'%6 'IVY W. Ellis
Approved for bedrooms. '7.'•.
1.► CE-tos77
Disapproved. �' •. F
�ssioi�n
x �c�
Conditional approval for �_ bedrooms, with the following stipu
At the time of title transter, the new property owner shall sign the attached
maintenance agreement which shall be returned to this office before an
unconditional approval is issued.
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: l'�'�^� LJ Original Certificate Date: 6 _ - ob�
(Ra Oil=
Municipality of Anchorage
• Development Services Department
Building Safety Division '
On-Sfte Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196550 Anchorage, AK 99519.8850
www.nwni.org/onsito
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Greenland S/D. Block 6, Lot 6 Parcel ID: 015-171-20
A. WELL DATA
Well type Pri
Date completed 1971
Total depth L5_11.
Date of test
Static water level
Well production
If A. S. or C provide PWSID #
Sanitary seal mm )L -
Cased to 75 ft.
FROM WELL LOG
NA
NA
ft.
NA g.p.m.
WATER SAMPLE RESULTS:
conform —L—colonies/100 ml.
Arsenic: NA mg.A.
B. SEPTICIHOLDING TANK DATA
Nitrate 1.84 mg.A.
Date of sample: GW5
Tank TypelMaterial steel 3116" AdvanTex
Tank size 1500 gal. . Number of Compartments 2
Well Log (YM) N
Wires property protected (Y/N) Y
Casing height (above ground) 29 in.
AT INSPECTION
6/13/05
24
ft.
g.p.m.
Other bacteria 0 colonies/100 ml.
Collected by: C. Ellis
Date Installed 6114105
Cleanouts (YM) Y
Foundation deanout (Y/N) Y Depression over tank (YM) N High water alarm (YM) Y
Date of pumping NA Pumper NA
C. ABSORPTION FIELD DATA
Date installed 6/14/05 Soil rating (g.p.d./fl2 or tt2/bdnn) 66_0
Length 15 ft. Width 5 ft.
System type 5 -wide trench
Gravel below pipe 0.5 ft.
Total depth 4.1 ft. Elf. absorption area L5-11? Monttoring tube Y Depression over field N
Date of adequacy test NA Results (Pass/FaiQ NA For NA bedrooms
Fluid depth In absorption fleld before test NA In. Water added NA gal. New depth NA in.
Elapsed Time: NA min. Final fluid depth NA In. Absorption rate >- NA g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NA If yes, give date
D. UFT STATION
Date installed 6/14105
'Pump on' level at 32 in.
Datum bottom of tank
E. SEPARATION DISTANCES
Size in gallons100
'Pump ofr level at 22 in.
Cycles tested NEW
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilifl station on lot 102
Absorption field on lot 120+
Public sewer main 100+
Sewer /septic service line 60
Manhole/Access (YIN) Y
High water alarm level at 36 in.
Meets alarm & circuit requiremerrts9 YES
On adjacent lots 1100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 25+
Water main 100*
Wells on adjacent lots 100+
Property one 40 Absorption field 17
Water service One 70 Surface water 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5 (1995 bad -waiver) Building foundation 50+ Water main 100+
Water Service Ane ro+ Surface water 100+
Curtain drain none known Wells on adjacent lots 100+
F. COMMENTS
1995 bed retained and reduced in size.
G. ENGINEER'S CERTIFICATION
I cer* that I have deferrnined through ffe/d inspecdons and
review of Municipal records that the above systems are In
canhxmance VAM MDA HAA guidelines in effect on fhfs date.
Engineer's Printed Name Cindy W. Ellis
Date 6/17/05
Driveway, parldngNehide storage 75+
HAA Fee $ 4t�O Zb �V.Valver Fee $
Date of Payment � y� jyon r� Date of Payment
Receipt Number Receipt Number
(Rev. 12001)
F W. Ellis
'IQrfA =
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
ANDylinCP S[tt�nn„�5�,
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
�day of� of206�byandbet%% Vatice SQsinow5W,
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as Adyati ig A)( -2A located
at ¢n land 5/A 1 81k �� (-off 5 Anchorage, Alaska.
AkeL 4l02o E , 113%' Ave.
2. Definitions.
A. Alteration. Any change to the design or function of an AW WTS that
includes the installation or removal of any parts, components or pieces
not included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AW WTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AW WTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of -- �Q1'10
($ —0-0t, payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term'of this Memorandum of Understanding shall be for the life of the
AW WTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AW\1'TS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
S. Alterations, installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AW WTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner: Y an u ' C&S t rt dWS
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
ONVNER: q
By:�� Ill
Date:-6—DS—
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
)MUNICIPALITY:
By:
Title:
Date:
) ss.
The foregoing instrument was acknowledged before me this& day of
20D5by (/ft ,t.GC 7 SdT,ncwSKi, the Stype pit
NUFARY PUBLIC FOR ALASKA
My Commission expires: L
of
-E A -S]' -1131K -AVENUE --
S 89°49'21 "E 100.00'
WELLO
` 1
tAm
ADg7HON
CEO
DECK
ALLEY
/ FILTER POD
�0. MANHOLE
\ PUMP VAULT
NOTE:
NO EASEMENTS APPEAR ON THIS
LOT ON PLAT P -:P8
THE BOORMATON HEREON m FOR THE USE OF LENDNO MSTITV no B SPEC"OALLY TO NOW ANY CONFLICTS BETWEEN
MSTNO STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND NOT TO BE USED FOR POSITOMNO ADDTANAL
STRUCTURESORFENCEUNES.
EASEMENTS OF RECORD. OTHER THAN THOSE KNOWN ON THE RECORDED PLAT. ME FAT NONAN HEREON.SR&ESS INDICATED)
NOTE: ANY FENCELMS SHAWN ME LOCATEDARPROX TELY ANDME NOT TO BE USEDTO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
MY PAWNO SHOWN HAY BE APPRO% TE DUE TO SHAW CONDRHONS.
o � ..�F.q.q
S Q
`49 TH*
...........................
SHANE A. HOLT
4
LS -6914
pptl en ...... AypO
AS -BUILT SURVEY (NO CORNERS SET THIS DATE)
T- • SO
1 HEREBY CERTIFY THAT I HAVE PERFORMED A
MORTGAGEES INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT S. BLOCK 6. GREENLAND SUB.
ANCHORAGE RECORDNO p ICT. ALASIA AND THAT
THE Vw'S,E NPROVEMENTS SITUATED THEREON ME
WITH" THE PROPERTY UNES AND NO WSIBLE
ENCROA ENTS MST OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA THS 16TH_
DAY OF JUNE m—
HOLT LAND SURVEYING 97N. FB lMHl.N
TEL SLY..11]
SINGLE FAMILY
FRAME HOUSE
p
O
CO
Do
Y-
tAm
ADg7HON
CEO
DECK
ALLEY
/ FILTER POD
�0. MANHOLE
\ PUMP VAULT
NOTE:
NO EASEMENTS APPEAR ON THIS
LOT ON PLAT P -:P8
THE BOORMATON HEREON m FOR THE USE OF LENDNO MSTITV no B SPEC"OALLY TO NOW ANY CONFLICTS BETWEEN
MSTNO STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND NOT TO BE USED FOR POSITOMNO ADDTANAL
STRUCTURESORFENCEUNES.
EASEMENTS OF RECORD. OTHER THAN THOSE KNOWN ON THE RECORDED PLAT. ME FAT NONAN HEREON.SR&ESS INDICATED)
NOTE: ANY FENCELMS SHAWN ME LOCATEDARPROX TELY ANDME NOT TO BE USEDTO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
MY PAWNO SHOWN HAY BE APPRO% TE DUE TO SHAW CONDRHONS.
o � ..�F.q.q
S Q
`49 TH*
...........................
SHANE A. HOLT
4
LS -6914
pptl en ...... AypO
AS -BUILT SURVEY (NO CORNERS SET THIS DATE)
T- • SO
1 HEREBY CERTIFY THAT I HAVE PERFORMED A
MORTGAGEES INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT S. BLOCK 6. GREENLAND SUB.
ANCHORAGE RECORDNO p ICT. ALASIA AND THAT
THE Vw'S,E NPROVEMENTS SITUATED THEREON ME
WITH" THE PROPERTY UNES AND NO WSIBLE
ENCROA ENTS MST OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA THS 16TH_
DAY OF JUNE m—
HOLT LAND SURVEYING 97N. FB lMHl.N
TEL SLY..11]
MUNICIPALITY OF ANCHORAGE
° DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# 01 5— I – o'` HAA#
1. GENERAL INFORMATION
Complete legal description Lot 5; BCock 6; Gne.enP.a.nd Subdiv,L6ion
Location (site address or directions)
4620 113th Avenue.
Anchonaae, AK
Property owner Jim 9 Nancy Ge-tchat Day phone (503) 473-2948
Mailing address _ 851 "F" S.tne.et we.6 Vale, OR 97918
Lending agency
Mailing
Day phone
Agent
John
B2a i.ngd Cotdwett
Bankze L Day phone E(- 378
Address
- 2801
"C" S.t)Le.e..t
Anchonaae., AK 99503
Unless otherwise requested, NAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ALDEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(R".1/91) Front MOAa21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm _ S & S ENGINEERING Phone
I 10J4 Eagle River Loop Road No. 294
Address Eagle River,,Alaska 99574 f
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
u rhr.
(; `f -.1 - )- L•i i `I
�r� _Date /0/ �X7/°S'
of
bedrooms, with the following stipulations:
Date �S
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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 (Ray. 1/91) Back MOA x21
ROBERT C.
COWANCE
- 8801 r :'
bedrooms, with the following stipulations:
Date �S
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The 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 (Ray. 1/91) Back MOA x21
Municipality of Anchorage
DEPARTMENT 01= HEALTH & HUMAN SERVICES
Environmental Services Division
8261" Street, Room 502 U Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: l..nr Ei, 6t vck (a 6Rear,�4No S�p Parcel I.D.: 015 �� a0
— —
A. WELL DATA r:>,, c,I
Well type 7FV f If A, B, or C, attach ADEC letter. ADEC water system number
-1I
Log present (YO 13 Date completed _ iJ / i< C1
Cno
Total depth 7 S- Cased to y I Casing height (above ground) _ I
d �
Sanitary seal &N) ��HS Wires properly protected (Pq) _times
FROM WELL LOG AT INSPECTION
Date of test �l / ` I o - 10 9S
r
Static water level a S
Well production g.p.In. — g.p.m.
WATER SAMPLE RESULTS:
Coliform O _ Nitrate 1 '7 ' Other bacteria U
Date of sample: — / o / o `1 .S Collected by: 5 r .S 6 rU G- t w z G-
SL'PTI OLDING TANK DATA
Date installed 10-11-q`, Tank size I-a5706,a L Number of Compartments a- Cleanouts O/N) Vcs
Foundation cleanout (9N) YES Depression (Yo 00 High water alarm &N) _V6-5
Date of PumpingIli
! F N K Pumper
C. ABSORPTION FIELD DATA
Date installed to - I (- P1 S Soil ratio (g..d./f ` or ft`/bdrni) 0.9 System type 5t5 -r>
Length -7h IWidth 15 Gravel thickness below pipe0 S � Total depth 5.0
Effective absorption area I I'io _ Monitoring Tube presentON) VES Depression over field (YA@)qt!
Date of adequacy test tisr Results (Pass/Fail) _ For bedrooms
Fluid depth in absorption Feld before test (in.); Inuuediately after_ gal. water added (in.):
Fluid depth __(ins.) Minutes later: Absorption rate g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date _
D. LIFT STATION
Date installed fo - II-yS Size in gallons I aSy GAL
�F
Manhole/Access(gyN) L/l=�S "Pump on" level at* `�a "Pump off' level at* 3a
High water alarm level at* 4LI *Datum "8ot'r' ore T"
Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se� folding tank on lot to I ; On adjacent lots
Absorption field on lot I a 5' ; On adjacent lots
Public sewer main -7G f- Public sewer manhole/cleanout
Sewer /septic service line �?5 + Lift station 10i
SEPARATION DISTANCES FRO SEPTI / OLDING TANK ON LOT TO:
Building foundation 2l' Property line 33 Absorption field
Water main/service line Io '1 Surface water/drainage 10"4- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Building foundation 55 Water main/service line
10 +
a3
too /t
Surface water too '* Driveway, parking/vehicle storage area So
Curtain drain tvot�E k"owOJ0 /4 W24'�OW UN%
Wells on adjacent lots 1 Property line 5
F. ENGINEER'S CERTIFICATION
1 certifv that 1 have determined thru field inspections and review of 1unicipal
in conformance with ti)A4A idelin�en effect on this date.
Signature, ' "F�"Q �--
Engineer's Name / ` lG i 0 t •i�nJ
Date 10 ( a- -5 / 9 5`
HAA Fee $ 01,�F-D ` OfZD Waiver Fee $
Date of Payment Date of Payment
Receipt Number 1` l % Receipt Number
Rev. 8/95 OSS: haa.wk.doc
a C?
x
frtl9l:kt'Cbtt)WrAN""t ^:
CE -8801
ar•e
#l: Time
Date
s�^
Insp
Jit_
,1UNICIPALITY OF ANCHORAGE
DFP OF HEALTH AND ENVIRONMEN' PROTECTION
.L Street, Anchorage, Ala.sxza 99501
t9t, .79-2511, ext. 224 or 2.25
Date Received: May 12, 1977
# i e _�.1)f1�-� dk3: Time
_.� --
t�[S Date !a-,3�77_%1�v1 Date
Insp 1Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Spokane Mortgag Compal
Mailing Address: 3201 C Street, _Suite �250Phone: 277-0543
No
3.
Property Owner: _ Larry E/Kathy_ L. Blagrove _ Phone:
Mailing Address: % Marston Real Estates, Judy Johnson 3494476 _
Legal Description • Lot 5 Block 6 Greenland^ Subdivision
4: Siegle Family Residence: (X) Number of Bedrooms i3_____
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: :[ndividual Well. (x)K Corununi`ty/Pub_l:ic System ( )
Permit # Depth of Well 75' Well Log on File ( }
Construction Bacterial A aalysis
6. Sewage Disposal System: On --site System Jx) Public Utility ( )
Permit ;t Installed 1971 Installer.
Septic Tank Size `� Manufacturer
Absorption Area � Soils Rate _ Material
7. Di.star).ces : Well to Septic Tank � to Absorption. Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
r..uNICIPAUTY ANCA" MUNICIPALITY OF ANCHORAGE
DEPI. O H. I .y DEPARTMENT OF ENVIRONMENTAL QUALITY
�NVI;.Ji Sewer and Water Section, Fourth Floor, 825 L Street, Anchorage, Alaska 99501
Attention: Laura Harrison
REQUEST FOR APPROVAL OF
'p V INDIVIDUAL SEWER and WATER FACILITIES
XI F� , „
1. Type of Inspection: CMRO
VA
FHA CONY XX
2. Property Owner- LARRY E. & KATHY
L. BLAGROV17
T
Mailing Address: unknown
Day Phone
3. Name of Buyer: RONALD E. & CAROL
A. BOLEY
Mailing Address:
Day Phone
4. Name of Lending Institution: SPOKANE
MORTGAGE CO.
Mailing Address: 3201 "C" Street,
Suite 250,
Anch., Ak. Phone 277-0543
5. Name of Realtor or Agent: MARSTON REAL ESTATE -
JUDY JOHNSON 349-4476
Mailing Address:
Phone 349-4476
6. Legal Description: —Lot 5, Block 6, Greenland Subd
Location: _ O'Malley
i
9
Type of Facility to be inspected: Single Family
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well 75'
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation May 1971
EQ -037 (1/74)
No. Bdrms. 3
Individual xx
1
Individual (on-site) _XX
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 6 Greenland Subdivision
Affadavit Attached: (') Letter Attached: ( )
Approved; Date: �S '"17 --
Disapproved: Date:
Department Worksheet:
ikAy 25, 19/7
f1Cfl i117F TIrtcjrtgc? Co)tt,t- 2'd;Y
rt;raOt r Suite 250
Mahorage:, Alaska 99503
aalr jE�t t: LOt S )flock 6 Go.reenl.and Subdivision
This .7epUrt:1:1e11t e0nducted an adequacy test on 'rhe Ejula;jext
proVerty art May 24p 1977. The test revc`gal.e d the absor pi_i ort
a naci€iqu t e fox --a three (3) bedreteart residence,
ence ,
The on•At3jte;s sewer system must l)e UP91racl0c by the addition of
an absorption trench to the: 0),isting absorptinxt yr3i t o .i"hc�
5pne;:l.Fiecations :dor tho upgrade are as follows
Trench KaeXditinn. Length " 48 teet
Total depth " 14 fest
Gravel backfill n 6 feet:
The wesll bas a crack.ocl sanitary Scml that; mustbe ral,bl.<ae:e+(l. The
Mal in above ground and easily ac.aessi.ble.
':IUM (let),Irtment would grant a teamporax,y A pa~ev,zl if fun(lt3 <�re
esrrOWd For thO capgr ide rel: tho ge�w�r, r�ygt ra)a,a aitarl th€� troll witl.
,a egtnplettic�,a sita o �7unea 30, 1.' 77. aw�arVIS €th01.11d also lac, se`t
to l wisp the sew-ctx 6-yru�e i as ne:odecl -umt-JI tiler aa�c;�a�ic: it
eaomol.et€a.
Im
�. pori—,.At for the mpgrEade is regia _rerl ancj thI aostr is 'j20.00.
XY* there are any Eurther c;(ucrstiansj, TSlat c;c�nt:ac•� tlti, office
at 279-2 51 e xtension 224 or 225.
Sincerely.
A..ieS DT. 2+1AcL7hCJll, R,).
%nzei 6:Ctritan
CC ° J11c'ly Jolinnon, Marston Read r';stat
