HomeMy WebLinkAboutGREENLAND BLK 6 LT 11MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251069
Work Type: Septic Upgrade
Tax Code Number: 01517126000
Site Legal Address: GREENLAND BLK 6 LT 11 G:2636
Site Mailing Address: 4721 Ell5TH AVE, Anchorage
Owner: WIITA BRYAN
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
��pctlp
S'
AM Wk
f,
Uepartrncnt
4/3/2025
4/3/2026
Q Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to
confirm minimum separation to impermeable soil and seasonal high groundwater, as well as percolation rate.
Construction may proceed at your own risk prior to 7-day groundwater monitoring. If results require a design
change, construction shall stop pending approval of a change order. Please submit results with the inspection
report (or change order, if required).
Received By: F S -S
Issued By:
Date:
Date:
4
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-171-26
Property owner(s) Bryan Wita Day phone
Mailing address PO Box 111762, Anchorage, AK 99511
Site address4721 E 11 5th Ave
Legal description
Greenland Block 6 Lot 11
Number of Bedrooms
Engineering Firm Forge Engineering
Building Permit Number
Not Applicable RN
APPLICATION IS FOR:
APPLICATION IS AN:
(Z all that apply)
Absorption Field
0
Initial El
Septic Tank
Upgrade F]
Holding Tank
❑
Renewal El
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees: # 6 q - Waiver Fees:
Date of Payment: 3/ Z Z-5. Date of Payment:
Permit No. 0 _5 P a5 106 9 Waiver No.
Phone- 907-343-7904
Distance:
March 25, 2025
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Greenland B6 L11 - 4721 E 115th Ave
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot needs to replace the existing lift station and septic bed on his lot. Due
to small space and adjacent well locations, the only feasible option without resorting to advanced
treatment is to rebuild the bed in place. The attached site plan identifies the location of the home ,
well, existing septic locations and information on adjacent properties. No conflicts exist between
this proposed system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot slopes fairly uniformly toward the northwest at about 5-7%. The bed
will be installed on slopes less than 10%, and there are no steeper slopes on site. Drainage arrows
are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not
impact this septic system. While the bed is being reconstructed using the original specifications
and test hole information, a new test hole has been specified to be dug prior to construction.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached
test hole logs, plan and secton pages for the septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251069, Curtis Townsend, 04/03/25
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//
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
GREENLAND, BLOCK 6 LOT 11
FEET
0 30 60
4-BDRM HOME
SEPTIC PLAN
4/2/25
E. 115th AVENUE
GA
R
A
G
E
EXISTING WELL
EXISTING 1500 GAL CONC
SEPTIC TANK
EXISTING 500 GAL
STEEL PUMP VAULT
DECOMMISSION PER
UPC OR REMOVE
EXISTING ABSORPTION BED
REBUILD IN PLACE
INSTALL MT AT EVERY
CORNER 1' FROM EDGE 18.0
20.0
50.0
10.0
LATERALS SPACED 5' OC
2.5' FROM ENDS
EXTEND TO 1' FROM BED ENDS1.0
1.0
2.5 5.0
TH#2 PERC
NEW 500 GAL EXPOY-COATED
STEEL PUMP VAULT
ENSURE 100' SEPARATION TO WELL
ENSURE 100' SEPARATION TO
ALL NEIGHBORING WELLS
CONFIRMATION PERK TEST TO BE
DONE PRIOR TO CONSTRUCTION
5%
5%
5%
5%
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251069, Curtis Townsend, 04/03/25
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
DESIGN FACTORS:SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 4 MIN/IN
APPLICATION RATE: 0.8 GPD/SF (BED)
SHALLOW BED ABSORPTION FIELD
EXISTING 1500-GAL CONC SEPTIC TANK w/
NEW PUMP VAULT
BOTTOM OF BED: 0.5' BELOW GRADE MAX
FLOW LINE ELEVATION: AT GRADE
PROVIDE MOA FILTER SAND AS NEEDED TO ENSURE TRANSMISSION TO RECEIVING SOILS
600 GPD / 0.8 GPD/SF = 750 SF BED REQUIRED (780 SF SPECIFIED)
4/2/25
PROVIDE ADDITIONAL FILL TO
ACCOUNT FOR SETTLEMENT
SEE PLAN FOR
DIMENSIONS
GREENLAND, BLOCK 6 LOT 11
6"
6"
2'
TOPSOIL & SEED
MAX SIDE SLOPES 3:1
1 1
4" PVC w/ 20 - 1
8"
ORIFICES EVENLY
SPACED @ 30" OC
DRAINFIELD ROCK
GEOTEXTILE FABRIC
AND INSULATION
MOA FILTER SAND AS
NEEDED DOWN TO
RECEIVING SOILS
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251069, Curtis Townsend, 04/03/25
— — — — -I- — — — — — — — — — — — — — — — — — — — — —
WOODEN FENCE CHAIN-UNK FENCE
O
o F_' x —.x—.x—x—x�._ x ALLEY
N -
- — — — — S 89'53'20"E : 100' .
Lot 11
8.8' 14.2'
18,000 s.f.
WIRE FENCE
SEPTIC PIPES----'
GRAVEL
rSEPTIC MANHOLE
1 _
00 i
8.0' x 12.0' SHED
WITH LEAN-TO
Lot 10 0
o Lot 12
C) 0 -
0 O
b p O
0 � O
O
Z / J N
2 .6' 3
40.6' W
1 STORY
/ * RESIDENCE
N U
WITH DAYLIGHT FW-
BASEMENT 0
/ 16.3' o a
16.0'
a O
OFCf- O
f 24.3' 16.8'
a.
ASPHALT 00
PAVEMENT M
N WELL
1
--- �— N 8 '53'20"W 100' — — — — -
0
M \ E. 115th AVENUE
NOTES: GROUND LEVEL IMPROVEMENTS SHOWN ARE APPROXIMATE. DATE OF SURVEY: 13 MARCH 2O25
PLOT PLAN �_ AS BUILT X_ SCALE 1" 30' GRID SW 2636 Project No J25-064 Al
Lang & Associates, inc,.O. urge, Alaska
• Anchorage, Alaska 99521-0005
(907) 522-6476 oa�p F A Opp
Professional Land Surveyors survey@langsurvey.com
0
I hereby certify that I have surveyed the following described property:
LOT 11, BLOCK 6, GREENLAND SUBDIVISION (Plat No. P-268) Q
Anchorage Recording District, g g Alaska, and that the improvements situated thereon are • • . .. • .. Q
within the property lines and do not encroach onto the property adjacent thereto, that Q
no improvements on the property lying adjacent thereto encroach on the surveyed Q • • • • • • • • • • • • • • • • • • • • •
premises and that there are no roadways, transmission lines or other visible QO70�� AT AN LANG ; o
easements on said property except cis
^ Indicated hereon.
7'h y--�:—=� F—� LS-9944. • ' JOD
Dated this the 2 -- Da of L 2 at Anchorage, Alaska D��A dooms
�44oIt is the responsibility of the owner to determine the existence of any easements, 0FfSSIONAL4pppoo
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Heallh Division ~9t f'- / 7 / -
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
q7 a~ ~_
lib- .I~
/
LEGAL DESCRIPTION
DISTANCES
~~. SEPTIC ADSORPTION
______ TANK FIELD WELL
WELL
LOT LINE
FOUNDATION I0
AS-BUILT DIAGRAM LShow Ioca0ou of well, sep0c system plopeHy hrles, Iounda0on,
TANKS
~] SEPTIC ,~t~o,'? [] t4OLDING
~et I
TYPE OF SYSTEM
TRENCH ~ BED ~ ~ W. DRA~N ~ OTHER
o,gJnw g¢sde + ~ U ~ O,~'- F~
1~ FT
WELLS ¢~
~ PRIVATE ~ OTHER (Identify)
FI[ FT
REMARKS: ¢~ ~¢~J¢ %¢p~'c
~n~ ~un~ ~ be tn~ co~d,/~o'L Ore~co
Inspecllons Porfo~ reed
~ .-, _ ~_ ' . '. ~,,~ ff/3o/~2
I .:- ~~ ~ cedify Ihat this inspection was performed according to
/ ,,,.~ ,~.,,,~-~ ,~. .
INSP£OTIO..~ R£PO~T
3500 EAST TUDOR ROAD
¢ ADMINISTRATION (g07) 7B~8301
~ PLBG. UNDGR. ~ ~
. ELEC, TEMP, ~ -
OOTING -- -- ELEC. SERVICE-:~...~ PLBG, ROUGH
FOUNDATION- '- []
½OND BEAM [] ELEC, ROUGH -~_,~ GAS TEMP,
:RAMING- ' [] ELEO. FINAL----'~,_ '~ GAS-
INSULATION [] OTHER- MECHANICAL
-- MECH. FINAL --
SHEETROCK ~ [] [] PLBG. FINAL
STRUCT. FINAL - [] FIRE FINAL "'
OTHER- [] ZONING--- [] OTHER-
JO NONCOMPLIANCE oBSERVED [~ CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
NEXT iNSPECTION __E~ DO NOT CONCEAL UNTIL REiNSPECTED
COMMENTS
.,..,' /
- :>','::.-'. ....... ,."."¢- ~: ,.4, "/; 1-'" ...... ~^T~
-- . :i ~ /,.,N~'PECTOR
;'f E
WCiEN CORRECTIONS ARE MADE, PLEAS CALL FOR INSPECTION
84-002 (Rev 10/86)
DO NoT REMOVE THIS NOTICE.,
MUNICIPALITY OF ANC-~o
DEPt. OF HE RAGE
ENVIRONM., ,~ ALTH '~
~'~IAI. PROTEcTION
JUL 2. 5.1989
RECEIVED
F:'I::iI~::IBiii~L.It::;,'IL D ]: ff;'T'l::t :[ E)L.J'I" :1: C)lxl E!;Y~!i'I"E!:I"i 'T'C] }?,ii!}: :[ hlii!;"rf'fl~.l....l~i::O :[ lq AI:::I2C)I:~DAI,,ICI'~!: I~J :1: I"H
!:i:l',li:..i :!: !,,ll!i:l!i:l::i ' 5~ :(:)[!i:Fi I [~.)1",1~ DI.IF!51 t:~Ei:C:l::il,'ll~'lliii:l',lDi!!l TI..I/..VI "l'Hl:ii: [:'il::il... ]: D I'::' :1: F:'li!i: I:;:'C)*L:~'T :!:
OF: 'i I'fE: l"l~lq :i: F:'!::iI...D :i31ii: I'::'l::i'.li~:!!ii!i:}LIl::lli~: '1' t!ii:!!~i'l"l~i:l::) I::'1::,i :[ CIl:i 'l"!:l B6'112!<:1:::' ]: L..I... :( l".1(3 ,, NC)T I F::'¥
DIII'I!i!1 t:::'1::~ :1: CII::;,' "l'i::} f.q.I.. :t: l'".l!iiff:'t!!i:C:T' :1: C}I',I~!!i ,, TI-I ]: 51 I:::'liii:F;~l"l :[ T :1: (ii~ ]: !i!i:!BLl[ii:D I:::CII::~ Zl !31ii:D ....
I::':i::)C]l"l !iiiil:N(:~l..t:~ F:Y.M"I:[I..Y I:]hlL'~"p ~l',l).:) li~:Xt:::'!:l::;:l:!i:liJ Cilq
Lot 11. Block 6, Greenland S/D
4721 East 115th
Septic System Upgrade
Specificntions and Design Notes
1. The design of the soil absorption mound is based on a measured perc rate
of 4 minutes per inch in the two foot thick SM stratum underlying the surface
organic stratum. The mound is sized on the basis of 125 square feet per bedroom,
which for this four bedroom residence requires (125) x (4) x (1.5) = 750 square ft.
2. The configuration of the mound shall be as shown on the plans except
that minor modifications may be allowed or required by the engineer conducting
the inspections. The shape of the bed may change slightly based on conditions
encountered at the time of construction.
3. It is understood that all of the wells shown on the site plan are private
wells serving single family residences.
4. AIl material specifications and construction practices shall be in
conformance with M.O.A. regulations.
5. The existing seepage pits shall be pumped and properly abandoned by
backfilling with clean soil. The septic tank shall be pumped to verify it's capacity,
and the inlet and outlet exposed to enable the engineer to assess it's condition.
6. A new 500 gallon steel septic tank, equipped with an "Orenco" lift station
assembly (or equal}, shall be installed after the e×is~ing septic tank on native soil
outside the 100 foot radius from all wells.
7. The mound shall be constructed by carefully removing only the surface
organic soil from the designated area, and a level surface created by placement of a
leveling course of medium sand.
8. A total of one foot of approved sewer gravel shall be ptaced on top of the
sand with the bottom of the manifold and the lateral distribution pipes located 8
inches above the bottom of the gravel.
9. The line pressurized line running from the lif~ station and the manifold
shall be 2" dia schedule 40 PVC. Approximately 5'of bridging 4" angle iron shall
be placed over the PVC as it exits the tank until it reaches undisturbed ground.
Special care shall be taken to thoroughly compact the soil under the pipes leading
into and out of the lift station.
10. The pressurized distribution laterals shall be 1.25" dia schedule 40 PVC
with 3/16" dia holes drilled in the bottom side on 30" spacing. The hole spacing in
adjacent rows shall be staggered.
11. The ends of each lateral shall be capped, and all pressurized pipe
connections shall be glued.
12. 4" dia monitor tubes shall be installed as shown, with the perforated
pipe extending to the bottom of the sewer gravel. Filter fabric shall be placed over
the top of the sewer graYel. The unclassified soil cover shall have a minimum
depth of 3 feet over the filter fabric, and the sides shall be sloped down at no
steeper than 3:1. '
13. Four inspection will be required during construction: (1) Initial
stakeout, (2) after excavation is complete, but before placement of sand, (3) after
the sand leveling course is placed, but before the gravel is placed, and (4) after the
gravel is placed, the lift station is installed and all the piping i.s connected, but prior
to placement of cover material.
14. The contractor shall be responsible for arranging for the necessary
utility locates, electrical permits and inspections. The on, off and alarm float
settings in the lift station shall be as specified by the lift station supplier.
l.o7' £
I
~ ' "~, " '2 ' " ' 5" " ' ? ',u : ~.
,,,THEODORE
..
LOT' I1~ r~l_OCI. C ~
~RD~NI.,~ND 5/0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
'7:. H.
PERFORMED FOR: d~r/L~
LEGAL DESCRIPTION:
I
2
3
4
5
6
?
8
9
10
11
12
13
14
15-
17
18
19
20
COMMENTS
~ THEODORE F. MOORE .' ~
.~?.. c~. ~ss, ...' ~.~
~?'2~'. ....... "~,~g
DATE PERFORMED: ~¢~
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
S
IFYES, ATWHAT $~,,~/~ ~t I0' 0L
DEPTH? p
E
Deplh to Waler Alter I 3' 0 ~/.,
I~onitoring? . late:
Reading Date Gross Net Depth to Net
Time Time (~.) Water Drop
PERCOLATION RATE _ ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ._.~.,'7~" FTAND. 8. 8~.~"_FT
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev, 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'TEST
PERFORMED FOR=
'~'\"-14 ' ' ' '~
,~ 4E GINEEI~S ~:,"~'~ ~
..'
DATE PERFORMED: ~/~ ~
LEGAL DESCRIPTION: ~.,.I/./ ~'.~
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
COMMENTS
Township, Range, Section: -r'/~/,f~ ~ ~,t,~ 5'~,c ~,~
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT SE ~t~'~ ~'' oL
DEPTH? p
E
Depth Io Water Aller I/~? fit.(/,n ~.~,
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
(minutes/inch) PERC HOLE DIAMETER
FT AND _ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES JN EFFECT ON THiS DATE. DATE: _ ~/~/~'~
72-008 (Rev. 4/85)
: ,..,, "::~: !'' .,/~,~ MUNICIPALITY OF ANCFIORAGE
,~'4.~ ~.' :' .-..i.. ,' [ eJ/~,-,-,\ Department of Hea th & Human Services
· '~;~,~:,~.~:~:~'~-~...:CERTiFiCATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF. r~.~,. :.~?.?: ? ·
/'~-~:. ~L' ON-SITE SEWER AND WATER FAC LITY FOR SINGLE FAMILY DWELONG
,'. ¢~'~i:'l.'D'.:/#'~%- ~ ~' ~ '.. HAA ~ · ~~.'~ '; - -'-' '" ....
,1. GENERAL INFORMATION (Must ue completed prior to submittal) .... ...-
(a).Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner [~o¥ ~c F~T~DEI'J
Mailing Address ¢-{7
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Telephone: (home) 3 ¥¢- ?.¢'¢ ¢_ Business
Address
Telephone
(e) Mail the HAA to the following address: (or check here I~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family {~ Number of bedrooms
3. WATER SUPPLY
Individual Well ¢ Community [] Public []
: NOte: If community well system, must have written confirmation from the State Department of Environmental
"'C0'nseCvation attesting to th legality and status. ' '
4. SEWAGE DISPOSAL
On-site [~ Public [] Community [] Holding Tank [] ' '
Note: If ~0mmunity well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status, ..
72-025 (Rev. 7/88) Page 1 of 2
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s!q~ jo uoBeSBse^u!/~ ~Pq),,~pe^ I '~oleq u~oqs elPp uo!iPp!lPA eq~ Jo sP pup o),eJeq pex!jJP IPeS ,~ ,~q pe!j!),Jeo sV
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~ MUNICIPALITY OF ANCHORAGE (MOA)
(~j~r,_~j/ Health Authority Approval (HAA)
~.~,.~,¢.jf// CHECKLIST- FEBRUARY 1984
MU N ici pA[':t.~E~ ANCHORAGE 343-4744
ENVIRONMENTAL SERVICES DtVIS[ON
Legal Description:
:',,~v,/I 4 1!)90
A. WELL DATA O [ t'~ r l
Well Classification _ /'"r"t
Well Log Present (Y/N) ~ Date Completed I?d '7
Total Depth c20' Casecl to ~- ?~' Depth of Grouting N,A
Static Water Level ~ '
Casing Height Above Ground _ I~ c,
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line /'4, ,4,
To Nearest Sewer Service Line on Lot
If A, B, C, D.E.C. Approved (Y/N)
Yield Z.~ ~o ~,P,~
N
N, 4.
Pump Set At ~ ,5'? /
Sanitary Seal on Casing (Y/N) Y'
Depression Around Wellhead (Y/N)
; On Adjoining Lots '~ f'oo '
; On Adjoining Lots __:> (oo '
To Nearest Public Sewer Cleanout/Manhole
~ ~r
Water Sample Collected by r='(~ ('/--~? T~c/~ ~',.. cr ; Date
WaterSampleTestResults -~¢<f,x.~C~c/~'t'/k' - ca
Comments _qJ-¢cxe-..f)/ ,/~,',~;~¢' o:(" cz,elf ~ /'~¢~,,m~/~
B. SEPTIC/HOLDING TANK DATA
Date Installed 7/ (-7 Size
Standpipes (Y/N) )/
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
15-¢~9..~, No. of Compartments /
Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) _Ix/.
I"/ Date Last Pumped ¢'/tZ/~-¢ /~y /~o1~ -f-¢oolc¢,~
/"/, ~. ; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~,~-'
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ~'¢;(a
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Fronl Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~' / ..~ ~" //~
Width of Field /,¢t '
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
~',/'¢,:~'¢'~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well I Oo' To Property Line IO '
To Building Foundation ~'O' To Existing or Abandoned System on
Lot ~ i¢' ~ ~f,~^cfo,~.X ¢-.,¢-,d¢~X ?',t' ; On Adjoining Lots ~:> ~'
To Water Main/Service Line ;~ ~,*f
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutback (if present)
~ ¢oo '
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for /~,~.
Meets MOA Electrical Codes
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Cor~ (~ :TI,5'"
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA g~.j~¢J,J~.e.~in effect on
inspection.
Signed ,~-~~~ ~. ~
Date ~ /[I / ¢0
MOANo, ~¢ -o[~
O ~'~
Receipt No, r~ /~Z,5~'- ~ Receipt No.
e.te of -¢-/¢ W.ive ee:
Amount: $ /~ '~ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
the date of this
Engineer's Seal
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 %" Street, Anchorage, Alaska 99503 274-4561
Date:Received ~.~2.~/-
Time of Inspection \0~ O0
~'~e' of Inspection
1. Approval requested by:
Mailing Address:
2. Property Owner:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Phone:
4.
5.
6.
e
Mailing Address:
Legal Description: ~ ~ ..
Type of facility to be inspected ~ No. of bedrooms
/
Wel 1 Data:
A. Type.~_J_~¢~ B. Depth ?0/
C. Construction D. Bacterial Analysis
Sewage Disposal System: (,..4~ ~(--~/--~c.~/~_~ ~
A. Installed~~¢i /~(~ B. Installer
¢. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2.
E. Disposal Field: Total length of lines
Distances: ~)~' ~'~'?"~'::].1
A. Well to: Septic tank j. ' 0.?¢ , Absorption area
Nearest lot line /P//~- , Other contamination
B. Foundation to septic tan~-'-" ?(~' i , Absorption area
C. Absorption area to nearest lot line
Material
_, Sewer Lines
FF)- (1~4 (117Z1~ ~
Page 2 of two pages - F
Illegal Description
lest for Approval of Individual ~wer & Water Facilities
Approved r.i~ .,,.: ,, ~'. :/]?+ /.,,~.,,,.>,-Disapproved Date
Approval ..Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
Ap?to:, :~o1~ t:,: Zo/
['certify that the ~nformot~on contained ~n this ~equest for app~ow] to be a t~ue and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily~
SIGNED (::~:A%Q.~
Date
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA FHA
2. Property Owner: )P,~$1~'~ <i. LIc)~:2tL~'
Mai-ling Address: ~/.?~t ~>~ //'~}~ A}/~'A._Day Phone
3. Name of Buyer:
co N v %-
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
D~.,y Phone
Phone
Phone
o
Legal Description:
Location:
' ....
7. Type of Facility to be inspected: ~,"7,~ ~ No. Bdrms.
8. ~ater Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
~f Zndividual, depth of well ':~:'
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
EQ-037 (]/74)
AFFIDAVIT
STATE OF ALASKA )
THIRD JUDICIAL DISTRICT) ss
, being first duly
sworn on oath, deposes and says:
1. That I am employed by Jack Benny's and Anchorage
Cesspool Pumping Service, Star Route A, Box 144, Anchorage,
Alaska 99502.
2. That on the 23rd day of July, 1975, Les ~,~C ,
a driver for this company, pumped the ceptic tank at the
residence of Carl B. Elsenbast, Lot , Block , Greenland
Subdivision, and it is my information that on that date the
meter indicated that he pumped 1,500 gallons from 'the 'tank.
3. That Les ~--~ is currently honeymooning
out of state; however, my information is based on the attached
statement completed by him on the day of pumping.
FURTHER your affiant saith not.
DATED at Anchorage, Alaska, this ~Z~ day of August,
1975.
Jack Benny's~ 6nd Anchorage
Cesspool Pumping Service
SUBSCRIBED AND SWORN to before me this
August, 1975.
day of
Notary Public in and for
the State of Alaska~
My Con~ission Expires:
