The URL can be used to link to this page

Home My WebLink AboutROLLING HILLS ESTATES BLK D LT 15Rolling Hill Estates Block b L. ot 15 #011-072- 39 10' UTILITY EASEMENT LOT 16 LOT 4 LOT 5 LOT 6 LOT 14 LOT 7 EXISTING HOUSE Steven Callaghan No. 12034 AS-BUILT 9/1/2023 05/31!2022 22:55 907-345-0202 ALPINE DRILLING PAGE 01/01 Alpine Drilling & Enterprises Well Log Permit Number: #SW221348 Date of Issue: 8-31-22 Parcel Identification Number: 0.1107239000 Date Started: 9=16-22 date Completed: 99-17 2222 Is well located at approved permit location? x Yes ❑ No Legal Description: Bolling Hills Estates Block D Lot 15 Property Owner Name & Address: William & Leslie Willenhrink 5219 Wandering Drive Anchorage Alaska Borehole Data: Soil 'lope, Thickness & Water Strata Depth (ft) From To Method of Drilling x air rotary ❑ cable tool Casing tyke: steel stick up 0 2 Wail Thickness: _250 inches silt sandy salt 2 11 11 69 Diameter: d inches Depth. 138 feet Liner Type: Di eter. inches Depth: feet gravelly sandy silt 69 73 Casing stickup aboveground: 2 feet Static water level (from ground level): 87 feet silt 73 117 gravelly sandy silt 117 132 Pumping level: 132 feet after silly water sand c& gravel .132 138 2 hours pumping 50 gpm Recovery Rate: 50 gpm Method of Testing: air li Well Intake Opening '.Type: x Open End ❑ Open. bole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: Bent granules Volume: 21��s Doth: St 0 fbot Sto d ? feet Pump: Intake Depth feet Pump size _ hp Brand Name .... -- .-.._-- Well Disinfected Upon Completion? x Y°es ❑ No Method of Disinfection: chlorine tablets Comments - Well Driller. alpine Drilling & .Enterprises PO Box 110496 Anchorage AK 99511 CSD 31l3 -7m Sep_16.2022 02:56 PM Anchorage Well & Pump Service Inc 9072430742 #0416 P 1/ 1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: - - Parcel Identification Number: 011 - 072 - 39 Legal Description Block Lot Property Owner Name & Address: WILLENBRINK WILLIAM & LESLIE ROLLING HILLS ESTATES p 15 5249 WANDERING, DRIVE ANCHORAGE, AFC 99502 Pump Installation Date: 09 - 15 - 2022 Pump Intake Depth Below Top of Well Casing; Pump Manufacturer's Name: FRANKLIN Pump Model: 1 OFRD07P4 Pump Size: .75 hp Pitless Adapter Burial Depth: 10 Pitless Adapter Manufacturer's Name. Pitless Adapter Installer: 132 feet feet BAKER Well Disinfected Upon Completion? Yes 0 No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMp SERVICE Company: 7640 ICING, STREET ANCHORAGE, AK 99.518 Sep_16.2022 05:54 AM Anchorage Well & Pump Service Inc 9072430742 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • �"" on -Site Water and wastewater Section www,muni.org/onsite Well Decomn71SSioni Subdivision DOLLING HILLS ESTATES Block D lrot 15 T_ R� _ Section _ Lot_,._ on-site Water & Wastewater Section certined contractor performing the welt decommissioning: Name: TYLER RIDGWAY company: ANCHORAGE WELL & PUMP SERVICE Well decommissioning date 09/15/22 } #0369 P 1/ 1 907-343-7904 Fax: 343-7997 Method of decommisslaning: AMC 15.55.0$OL1 a. ❑ b. ❑ C. ❑■ Location: Use the space below to provide a drawing of the property showing the following items; • North arrow • Decommissioned well location • Location of other water wells on the property rwo separate swing-tle distances for each well shown on the drawing Note: The swing -tie dlatances shall be measured from either permanent structurea or the property corners. 9 Wandering Dr, Anchorage, AK 99502 OLP W MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP221348 -- -_... Work Type: Well Upgrade Tax Code Number: 01107239000 Site Legal Address: ROLLING HILLS ESTATES BLK D LT 15 G:2124 Site Mailing Address: 5249 WANDERING DR, Anchorage Owner: WILLENBRINK WILLIAM & LESLIE Design Engineer: This permit its for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy 111enr S�^ rJ_ Del rtinent v Effective Date: 8/31/2022 Expiration Date: - . _8/3112023 Lot Size in Sq Ft: 34350 Total Bedrooms: 4 Q 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 Provisions: rToclose this permit please submit: 1. Well Log . 2. Pump Install Log 3. Water sample results 4. Well Decommissioning Log Received By: Issued By: _ Date: �C 3/ l �L Date: g 1 Z MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 00 - 07Z" 3 / / / Property owner(s) W 11 (a h, - a! e5 I F� d Ul lI et7b- }1'C Day phone qa 7 35/ -8'01 Mailing address ._AY C( (t/OhArmn /.fit' At\c!<a)-AV-e_ 41e %9542 Site address 5-2110 (t/Gh rlerin c; %fir A hcAara6e,_ /4/L 7I36rZ Legal description (Sub'd., Block & Lot) 2d/1t'ha Nt 16 tf,f4fics a block D lof 15- Legal SLegal description (Township, Range & Section) Lot Size 31, 350 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank ElUpgrade R (w/wo ADU) Holding Tank ❑ Renewal❑ Duplex (D) ❑ Multiple Dwellings ❑ Privy ❑ D-�-dj flet~/ (SF and/or D) Private Well ® 4/21i Water Storage ❑ I THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) erm' Rush FeesA 30 Waiver Fees: Date of Payment: 9 131 b_ Date of Payment: Receipt Number: D115 i�) Receipt Number: Permit No. 5"f Waiver No. GMevelopment serviceslBuildingSafetylOn Site Water and WastewaterTorms\client FormsTermitApplicalion.doc I L {{HOUSE'' _. ,� f€€€€ `€;HOUSE �=,'i3i € •r o y €HOUSE LOT 4 LOT 5 '� SEPTIC SEPTIC \ ` AREA r. ^ AREA r ------------------ ----------------------- --- ---a `-- LOT -6 4 -l- - ---- - --- ------------- _ ,`+ �', I°SEPTIC LOT 'i 5, BLOCK "D" 'CONSTRUCT NEW 1 AREA /1 ROLLING HILLS SID 72' LONG SOIL ABS. TRENCH W. 7' GVL. T.H. EXISTING TRENCH ` , LOT 1 INSTALL NEW 1250 -GALLON ♦ ♦ "BULL RUN" —SEPTIC. TANK T—DIV. VALVE SEPTIC -� ', NEW M.T. AREA `, ► ABANDON o �` EXISTING 3{i ='?€, SEPTIC o BDRM!' "HOUSE 60 �,� TANK o SEPTIC _ _ _ =; /o�'� AREA r � ' WELL �R 10a + �• } =2::=,:_:_ , =3' _• I `'HOUSEit O LOT 14 R 1fl� r z€iilii3?€=i +� WELL. 1 + WANDERING DRIVE- ---------------------------=-------------- _1�`r _ _ LOT 13 LOT 12 .' L OC b on {'}'I ee f LOT 15 s►D G f SEPTIC SYSTEM UPGRADELS R i � i'Y►v1� i �� v�rewley �S _ -- SITE PLAN / NOH =-50f-EET- PRAWN BY TFM MAY, 2001 /3 Z ----------------- NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. May 05 22 11:35p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department t Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 011 072 39 Legal Description Block I Lot ROLLING HILLS ESTATES I D 1 15 Pump Installation Date: 05 - 03 - 2022 Pump Intake Depth Below Top of Well Casing: 115 Pump Manufacturer's Name: BERKELEY Pump Model: S 10P4HS05231-03 Pump Size: •50 Pitless Adapter Burial Depth: 12 Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Date of Issue: Property Owner Name & Address: WILLENBRINK WILLIAM & LESLIE 5249 WANDERING DRIVE ANCHORAGE, AK 99502 feet MARTINSON t Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET Company: ANCHORAGE, AK 99518 907-243-0740 Mailing Address: City: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage :'::.~ Development Semices Department "· Building Safety Division On-Site Water end Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, N( 99519-6650 Page www.ci.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. ..C I,t.t (~1 C~(~' ~ PID Number:. ~'"~ ~ ~n ~ I'G~f~y "['u.t'/IC. Wastewater System: [] New [] Upgrade '~'" ~'z¥~ /x/a/~d-~n,~, ~/". /~¢4 99~-oZ. ABSORPTION FIELD LEGAL DESCRIPTION o. fi" ~,v~' I'& O ~, Well: ~y, aj'?- [] New [] Upgrade '~. SEPARATION DISTANCES [] septic I-I Holding ri S.T.E.P. I'-I Other:. T. _~*~.,.~_ ToSeptic Ab$orptior Lift Holding public/Private .... ' Field Station Tank Sew~' I. lne ' /~r~) CJ') O t'~q~ Tank ~.. IOq' I'ZZ.' -- - ~.-z6-~ ,Cf¢¢1 ,--... >,oo.~ ~' ,,,~.,,,. _- ..\V/~.. .__."' STAT,ON ,~.~. ~'"~ BENCH MARK Engineer's Stamp Inspections performed by: ~'l~,/-~ja 7'ec/~ J%"(- Dates: 1" ~5'/~'/0! t~, ~..- -~:a:-~ )-x"~n'rH ;'~x .:,~./~. Reviewed and approved by: Date: PERMIT NO: SW010162 PAGE 2 OF 3 PID NO: 011-072-39 SWING TIES: FROM: COR."A" COR."B" TO S.T.C.O. "C" 20.5' 34.5' S.T.C.O. "D" 26.5' 41' DBL. C.O. "E" 29.5' 45' VALVE "F" 30.5' 44' TR. C.O. "G" 33' 47.5' TR. M.T. "H" 63' 78.5' TR. C.O. "1" 103' 119' OLD TR. C.O. "J" 37' 65.5' .WELL LOT 15, BLOCK "D" ROLLING HILLS S/D NEW 72.5' LONG SOIL TRENCH W. 7.1' SEWER GRAVEL Fle ORIGINAL TRENCH NEW 1250-GALLON · SEPTIC TANK LOT 15, BLOCK "D", ROLLING HILLS ESTATES SEPTIC SYSTEM UPGRADE AS4~UILT INSPECTION PLAN VIEW FLATTOP TECIINICAL SERVICES 14530 ECIIO STREET ANCI IORAOE, ALASYJ~ 99~; 16 SCALE: 1" = 30' DRAWN BY TFM JULY, 2001 PERMIT NO: SW010162 PAGE 3 OF 3 PID NO: 011-072-39 r~ rl~ :,, 4' SOIL COVER' 97 .3 , ' , ' NEW 1250-GALLON ' ' 93.6' SEPTIC TANK i , ,' ,' / ,,; NEW72.5 LONG i ,'', , , SOILABS. TRENCH i ' ' '' GRAVELI ' , ,, W 71'EFF ,, BOTTOM TRENCH ELEV. 85.3' ' ' ,,,, ~'[."49~/'4~ %~ ,", ,,oTTo,,, T... ,,, .. · . ELEV. 79.0 ', ', - L': '. . .,(: ~ 5/23/01 .".. . ...'..' LOT 15, BLOCK "D", ROLLING HILLS ESTATES SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION PROFILE FLAI'rOP TEC![NZCAL S~P. VICES NOT TO SCALE 14~30 EClIO STP. E£T DRAWN BY TFM ANCI lOP. AGE, ALASY. A 99516 JULY, 2001 MUNIClPALIT~ OF ANCHORAGE Development Services Depa~fmenl On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 05, 2001 Expiration Date: Jun 05, 2002 Permit Number: SW010162 .'Legal Description: ROLLING HILLS ESTATES BLK D LT 15 Design Engineer: 0019 Flattop Technical Services Owner Name: JAMES & KATHY TUTTLE Owner Address: 5249 WANDERING DRIVE ANCHORAGE, AK 99502-1927 Parcel ID: 011-072-39 Site Address: 005249 WANDERING DR Lot Size: 34350 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] 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 noti~ 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, sealed, and heated to prevent freezing. Received By: Issued By: 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]VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. or! -- C~'"'/z - 39 Permit Number Propertyowner(s) ,.~-wt~' ~ /,c~/--~,;t 'T'~/"/'/~- Mailing address (1) ~Z¥~) ~.z~',~,~f,,,,'.,,,/~ P~'~ ,,'¢ Mailing address (2) ,A~,.~<:, ~',~,,,q'~,, Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 3 4., Acr~Q Number of Bedrooms Day phone Zip Code qe, s-o ~- 1'/27 /-/-,/Lr THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi Water Softening Unit 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 property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: CIVIL & ENVIRONMENTAL ENGLNEER~NG" ENERGY CONSERVA'I~ON & ANALYSIS TIIEODORE F. MOORE, P.E. 14530 ECHO ST. PII: (907) 345-1355 ANCIlORAGE, ALASKA 99516 May 29, 2001 M.O.A. DIIHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: 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 15, Block "D",.Rolling Hills S/D, located at 5249 Wandering Drive. The original soil absorption trench is no longer able to accept the wastewater flow generated in the residence. 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 below 1.0 foot is a brown, silty sand with a measured pert rate of 7 minutes per inch. Using a slightly conservative soil application rate of 0.6 gpd/sq, ft., this 4-bedroom residence requires a total absorption area of(4 x 150)/0.6 = 1000 square feet. The proposed 72-foot long trench design with 7.0 feet of effective sewer gravel has a total absorption area of 1008 square feet. The topography of the lot in the area of proposed construction is generally level. 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 ifyou have any questions on this submittal. Sincerely, Ted Moore, P.E. LOT 4 · · · SEPTIC LOT 5 · SEPTIC · AREA ......................................... "~,, CONSTRUCT NEVV LOT 15, BLOCK "D" LONG SOIL ABS. ', ROLLING HILLS SID TRENCH W. 7' GVL, " T.H. __ EXISTING #1 TRENCH LOT 16 INSTALL NEVV · 1250-GALLON ~ · "BULL RUN" . SEPSLC, ~'AN.K ~ VALVE SEPTIC .. - - ' ' ' ' ' ' - - ..'-.M.T, AREA - ' ' ' ABANDON · · ' EXISTING · · ' SEPTIC · " ', TANK '-. ,' , .~ ~ SEPTIC '., , AREA ' "R 100' ? , WANDERING DRIVE '" ~.'? LOT 6 SEPTIC AREA ! t % LOT 14 ,' LOT 12 LOT 13 LOT 15, BLOCK "D", ROLUNG HILLS SlD SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECII~'~CAL SERVICES 1 INCH = 50 FEET 14530 ECIIO STREET DRAWN BY TFM ANC110R~GE, ALAS:ICA 99516 MAY, 2001 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. SEPTIC TANK PLAN VIEW SCALE: 1" -- 10' )NITOR TUBE -- CLEANOUT iACKFILL 6" ORIGINAL GROUND FILTER FABRIC -- 4" DIA. F-810 PERF. DIST. PIPE 2 1/2" SEWER GRAVEL -- BOTTOM OF EXCAVATION SECTION "A" - "A" SCALE: 1" = 5' LOT IS, BLOCK "D", ROLLING HILLS S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLA'rI'OP TECIINICAL SEAs/IC-ES [ SCALE: AS SIIOWN 14530 ECIIO STREET I DRAWN BY: TFM ANCl IORAGE, AK. 99516 MAY, 2001 Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 15, Block "D', Rolling Rills S/D 5249 Wandering Drive Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope ofthe project consistsofabandoningancxisting 1250-gallon septic tank and installing a new 1250-gallon septic tank, which discharges effluent into a new 72-foot long soil absorption trench containing a total of 7.5 feet of sewer gravel. A "Bull mn" diverter valve shall also be installed allowing septic tank effluent to be switched back as desired to the original trench, which shall have a new monitor tube installed. 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 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. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement oftopsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250-gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each 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. 2.2 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 cleanout shall be installed within 4 feet ofthe building foundation, and a double cleanout shall be installed within 5 feet downstream ofthe septic tank. 2.3 A "Bull Run" diverter valve shall be installed in the waste line downstream of the double cleanout allowing effluent to be diverted back to the original trench, as desired. A new 4-inch diameter perforated monitor tube shall be installed in the original trench extending to the bottom of the sewer gravel. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 72-foot long trench to a depth of feet below original ground level in the vicinity of test hole # 1. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal specifications. 3.3 A total of 7.5 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 7.0 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 ofthe sewer gravel. A minimum of 2 feet ofsoil cover is to be placed over the filter fabric. Ifthe 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 ofthe cover material shall be raised a minimum of 6 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 of4 engineedng inspections will be required during the course ofthe 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 ofthe above inspections. 4.2 The installer shall coordinate the timing ofthe irispections with the engineer sufficiently far in advance to ensure the availability of the engineer. I TESTHOLE# ! LEGAL DESCRIPTIOH: Lot '15~ Block #D'~ Rolling Hills $/D FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: May 15, 2001 PERFORMED FOR: ,,Jim and Kathy T~t'de DEPTH -- (feet) Pt. SM Brown, sitty, finesand Moist in upper 6' Denser below 12' Pockets of SW below 17' B.H. 6- 7- 8- 9- 10- 11- SLOPE SITE PLAN e,,/--WELL Depth to Groundwater Date ._NNo_G.['oun_dwat er 5/_15~2001 18.1' B.G.L. 5/23/01 Clock Nat Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 5/15 12" Presoak 27 1/2 R_esoak 27~i8 Add water & start 11:45:1._5 23_3/8 #1 12~5;_15 30 1813/_16 4 9/16 Add water 12:15:40 23 7116 #2 12~5:~0 30 18718__ 4 9116 Add water 12L46 23 1/2 #3 1;16 30 19 4 1/2 PERCOLATION RATE 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 7.5 FT AND 80 FT COMMENTS: PERFORMED BY FLATI'OP TECHNICAL SERVICES. I a~.,~ ~ CERTIFYTHAT THIS TESTWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEMNES IN EFFECT ON THIS DATE. DATE: ~,,-~'~ /of MUNICIPALITY OF ANCHORAGE DEPARTNIENT 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 PHONE J~.N EW {~]UPGRADE ~MAI LING ADDRESS t"~. LOC&TION -- ~ ~ t ~ ' - NO. OF BEDROOMS ~ell~ ~ ~ ] Absorption~r~ { Dwelling,~ ~ PERMIT N~ ~/ t ~ ~ DISTANOE TO Well Dwelling I PERMIT NO. i~ Manufacturer ' Material Liquid capacity in gallons O IWell ~, ~ . .~ Foundation .~¢ ~ INearestlotline~ IPERMITN~ ~ .~/ · I No. ILength of~ac~ I~e Total ,~.~th~i.~ I mrench i ] Distance bet~e~es ~ I [ I ~/ ~[ ~ inches ~ . ~ ~ I Top of tile to finish grade __ Material beneath tile~_~ ~ Total effect~o~tlon area ~ Length Width~ Depth /~ Inches I PERMIT N~~ ~ ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~ Well Building foundation Nearest lot line ~' ~ DISTANCE TO: ~ ~CI~s Depth Driller Distance to lot line PERMIT NO. ~ ~ Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PiPE MATERIALS SOl L TEST RATINC~.- I NSTA L LEF~,~ REMARKS / DATE LEGAL DEF'FtRTHENT OF' HIEi:::tL. TH !::IN[) E;.:N',,,' ;[ F.: :'.' Ffl"tFJi'..TFI[. F:'I:;:C)TI!!i; T T :[ OIq ' ' "f'Hl::: t:;i:!E(;:!U :[ RED ':: T ":'E' Cfi:: 'T'HI~E ':: r't ]: L. FIE ':..':;" F.'P'T :t' C i',,I :?.?STEH T "5 ' THE LE:t",IGTN D :[ HEIq':'ii; !: ::; F! :!: S 'THE' LENGTH ,' ]:i",t I:::'EF!!:T ::, q.F THE: TFdEI'-,IC:N ':' 'T'!'"tE DEF'TH qF FI TREt'.,!C:H OR t::'.~T :l:S T:HE;...J~,;[STI:::I!'.,ICE~ E;ET'k!E:.E:N THE. ::.~;I...II:;i:I;::'F:IC:E r"l::: T'I...IE: GI:,:':CIUI",ID FIN[) THE [:: '~" 'TT ~l?t OIz' THE E:;:':,CI:::I"v F:rT' ~ Cff-,'~:~:!: i',! F:rIEET ::'. 'T'HEF:E: ]:S NO SET !.,.I:[DTH I:::'31:(: TREi'-,I(::NIE'.:3. \ THE ~' ~ ," iS ~r ,Ir: ..... ~f I,I:.L [:'E(F'TH THE: I"t]:I",I];!"ILtH [)E:F'TH CI:: .......;:""' ~:'' E~[ETi.,.IE::Et",I THE ("ILITi::'i:::tL_[... Ir:rtl'q[:' THtZ E~O'TTEIH OF THIE [:.,.-,....['t,FII ~I:IN "]:!",t FEET). t::'E:I:;;:H ]: "i" I:::IPF'L ]: :' F:Ii'.F[' l'"ll:::f:i.:.; THE l:;i:[:::'.:~ F'" t'.!'F T ::~ T t. :[ 'T".? TCt ]: i'.,It':OI:;i:H "l"t'"t :I: :~i; [:,F.':.t::'F:.F"TH.E:i",!T !::,l...il;;i: :[ I",tCii THE: T i'.,l'::: "f't:::It. L FrT' :[ ON .~ NSF'ECT :1: Ed'.,l:~; O1::: F:ll",!"r' I.,.IE[...LS F:It:':,J'FtC:E:NT T "i "I"H :[ 'E, F"F.... F' ,.:': I: I ' I::II",tD THE: i"I Jt"IE E'IR '.)F F:E:S Z DENCE:S THFIT' THE klE:L.L 1.,.t:[ LL. S[~::tR',,,'E. i"1 :[ tq :!: I'"tL.tI"I [> t STI:::tt",!E:E E;ETI.,.!E:EN R .L,.!E:LL.. tZINK) F:!N"r' Ot",t-'S ].' TE :i!!;El.,.lf:!(.'.:i!.:i~. D I St::'O:~'~;t:::IL.. :!!i;"r':i:~;TIEH t :Er ::l..1;?.~l.3 F::'E:ET FEd:;?. 1:::t F'R]:',,,'Ff'f'E !.4EL.%.~ ::LSd;!) TO ;.?.E~EI FEi:ET F:'ROH F! Pt..t[ii~L..IC: klE:L.L DE:!::'EN[::']:NG LIi:::'ON THE "r'.?l:::'E OF !::'LtE',L.:[C 141EL. I ..... 141ELL LOEi:~:~; FIRE IRE1:;:!LJZt:;?.ED F:lt'.,!D f,ILI:ST ErE F,?.E?FUFd'.,IE.'if..':, TC) THE [:,I!ii:!::'F:tRTt'"tE:t'.,IT H I"T'H:[N :!i:~;~ [>FI"r'S OF: THE: t4EL. L COi'"IPL. ET]:I.3I"L OTHE:I:;i: F~:Ei:(;:it...I ]; F:EHE:t",!TS I"1Ft'¢ FIPF'L.."r'. SPEC :[ FI',,,'t::I :[ L..F:!BLE TC) ~ Nti.:.:;I...IF:IE F'RC)F:'E;R ]: NS't"I::IL. LFIT ]: OI",!. :[ CEI;E:T].'F~'r' 'T'F!f::!T ::1..: ;( i::!["1 FFII"t]:L:[RR N:[TN THE F;:E:g!LfZ!:RE:HENTS F'OI:;;: Cd",I"'"S]:'T'E~: :E;Et4E:f;-:.% FIND FOfR"f'H E¢'r' THE HUN :[ E: :[ PFtL. :1: T"r' OF:: FIt",ICHOFi:I::tGE. ;2: Z !.,.t :[' L.L. iNSTFILL THE ':'i;'-r":STE:l"l Ih,t F1CE:CIf~:DF:IF,IE:E: iq:['T!'.'! THE: C::EII:::,IE:~i;. ?.: ]: UNDE:I:;~:STFII'.,ID 'THF:!T THE ON-SITE: ~i.:;[.'-:t.,.t[ER :~;"r'STE'?I I'"tl:::t"r' I:;?.E:g!U]:I:;[:E ENL. F:tI:;~:C~iEHENT :;;:ERS :t: DIEI'.,Ir,::E..:[ :5 F:EHOf::,E':L. ED TO ]: F,ICLt. J[)E ."!:" ?[:!' T'NF:Jt'.,! 4 ~[~¢L.:[ CI::~f'.,rT" ..:ri::IP1[E:iJi; I...I. "r'I.J'TTL. E~: ,,, . :[ F ......... 1, Mr. John Bagoy c/o Karl 'Bachner 1135 W. 8th Avenue Anchorage, AK 99501 (907) 278-1551 4040 "B" STREET ~ ANCHORAGE, ALASKA 99503 Subject= Subsurface Investigation, Rolling Hills Estates Dear Mr. Bagoy= Block D, At the request of Mr. Karl Bachner, we have{~o~ducte~ the. subject exploration. The scope of the invebtigation includes test holes and percolation tests on lots 4, 5, 6, '7, 8 and 15, 16, 17, Block D., Rolling Hills Estates. Included with this transmittal are: ..~-~ Vicinity Map Test Hole Location Sketch -Test Hole Logs Summary of Percolation Test -Results Standard .Explanatory Info~,~ation Figure 1 Figure 2 Table A - Table 'B Sheets 1-3 Exploration was conducted on June 22, .1978. A Nodwe~'l . mounted Mobile Drill.B-5O rig was used. The drill[n~ equip- ment is owned and operated by Denali Driling, Inc. Test holes were located in the field and logged by Mr. Joe Williams~ staff technician with Alaska Testlab. As samples were recovered from the auger flights, .they were sealed in plastic bags for protection of the sample and 'maintainance of their natural moiture content. In the laboratory, the samples were visually classified and'the moisture content and dry strength of each sample was deter-' mined. When drilling was completed, a 3/4" slotted PVC pipe was inserted into each hole to aid in determining the free water level. For the percolation test the hole was filled with water and left overnight to saturate~ On returning the next day, the hole was refill,ed with water and the drop in th~ water level carefully monitored over the next 60.minutes .or longer if necessary in order for the rate to stabilize. .We understand this procedure is preferred.by the Municipality of Anchorage, Department of Public Health and Environmental Protection to evaluate the site for'proposed on-site sewage Mr. John Bagoy c/oMr. Karl Bach~e,r July 5, 1978 Page 2 treatment systems. Table B is a summary of the results: of the above tests. '~ .~,,~.~ No free' water was Observed in any of the test hol&'s~?, It should 'be noted, however,~ that the free water level~i!ma~. . fluctuate seasonally or with precipitation.. ~ :~..:~ We trust '.the above meets your present needs.. If you.?have, any questions or if we may be of further service, please not hesitate to contact us. Very truly yours, ~T.~SKATESTLAB Mark Hansen RMH~-rb Enclosures ROVED~ Melvin R. Nichols, P.E. Laboratory Manager Lot # 1'5 Depth in Feet Fr6m To 0.0' - 3.0' 3.0~ - 10.0~ 10.0' - 16.0' Table A WO #18498 Logged By: J. Willi~ Date:, 6-22-78 .~:~ .... Soil Descri ptlon ~ · ; F-4, brown Sandy Silt (ML) trace organics NP to P1-. ' F-4, brown slight!y Gravelly Sandy Silt (ML) P1%. F-4, olive to brown Gravelly Sandy Silt [ML) *Pi+,. Bottom of TestHole: 16.0' Frost Line: Free Water Level: None Observed None Observed Sample 1 2 ' 3 Remarks: 2. 3. 4. 5. 6. Type of Dry Depth M% Sample Strength. Unified 5.0' 19.6 G M ML 10.0' 21.1 G M ML 15.0' 14.8 G L-M ML Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. Dry Strength, N=None, L=Low, M=Medium, H=High. Group refers to similar material, this study only. General Info=mation, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see Sheet 3. TABLE Minimum Observed Required · , ' .;.' ,~ : .Percolation Rate, Abs.'.o~ption Area, Lo~ No. ' ._.. - ' Minutes/inch .... .-square feet/bedroom ; 4 /6.7 ~ 140 5 3.7 ' 110 6 10.0 165 7 6.7 140 8 .6.7 140 15 5.7 130~ 16 10.0 : 165 17 , - , 8.0 150 Because of the silty nature of the site soils and since silty soils sometimes tend to clog with use, we recommend a more 'conservative design value of 165 square feet/bedroom be used in spite of the above ratings. Date completed ........ ~..':...~..:...~.~ ............................................... Depth of well ...... i[5' Size of casing .......... ,.~....~.. ................................................................................... Distance to water ..... ~:~- / Distance to water while pumping .............. ~..?..~ ............................... at rate of ............. ~ ....................... gallons per hour. Formation to //2 OCT 2 i DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 RECEIVED F'ERMI~~ NO~ DEPARTMENT ~*-" ' ' ~" 'n ' . HEMLTH AND EN~I~_NMENT~L F~C~ITECTION 825 'L STREET, RNCHORAGE~ AK. 99L.£ 264-4720 ~.JELL F'ERf4 IT ( 800524 ) APPLICANT JAMES H. TUTTLE 840 W. ?~RD AVE. LOCATION WANDERING LANE LEGAL LOT:i~5 BLK D ROLLING HILLS EST ' LOT SIZE ~44-0052 ~7000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 108 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF-:I'-I I l' E~-=:P I RES DEm--~,,E~4BER 3t., 198E~ I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. S I GNED: APPLICANT JAMES H. TUTTLE V4. 0 ELL- L 01 ~.~ !J ICIPALIT°Y OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-072-39-000 Expiration Date: Legal description ROLLING HILLS ESTATES BLK D LT 15 Site address 5249 WANDERING DR Anchorage AK 99502 Current property owner(s) WILLENBRINK WILLIAM & LESLIE 12/5/2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 9/5/2023 ,This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-072-39 Complete legal description ROLLING HILLS ESTATES BLOCK D LOT 15 Location (site address) 5249 WANDERING DRIVE ANCHORAGE, AK 99502 Current property owner(s) WILLIAM & LESLIE WILLENBRINK Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 22 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 25 a Date of Payment S `1, COSA # Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: ROLLING HILLS ESTATES BLOCK D LOT 15 Parcel ID: 011-072-39 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 9//17/2022 Total depth 138 ft Cased to 138 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 8/10/23 Static water level at beginning of test 87 ft. Well production at time of test 4+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 8/10/23 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 48” Date of pumping 8/7/23 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/6/2001 ALL standpipes present per record drawing Total measured depth from grade 12.6 ft (max) Measured depth to pipe invert from grade 4.9 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 8/9/2023 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 8/10/2023 Results Pass Fluid depth prior to test 42 in Water added 600 gal New fluid depth 56 in Elapsed time 1440 min Final fluid depth 41 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 85 in (MOA 7.1’ ED) Effective depth used 41 in (Final Fluid Depth) Effective depth (ED) remaining 44 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 7.3’ ED existing. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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 Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/17/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/17/23 hAUNM P U 7 V OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT o On -Site Water and Wastewater Section � www.muni.org/onsite Holding Tank Advisory Certificate of On -Site Systems Approval # OSC231297 Subdivision: Rolling Hills Estates Block:D, Lot: 15 907-343-7904 Fax: 343-7997 The holding tank for this property is 22 years old. The average life for a steel tank is 20 years. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org ~' DATE RECEIVED I NSPECTI ON APPOI NTM E NTS ~.~,~ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTO~ , ~UNICIPALI~ OF ANCHORAGE ~ONIClPALITY OF DEPT OF I'::"JTH DEPARTMENT OF HEALTH & ENV RONMENTAL PROTEOT ~VIRON~'tE ~ 82~ L Street - Anchorage, Alaska ~01 M :N~A~ i.OTECT ON FEB z. I981 Telephone 264-4720 DIRECTIONS: Complete all parts on page t, I.~omplete requests ~ill not be pro~essed. Please allow ten (10) days for processing. ~AI~,~ ADD~ESS z ' PROPERTY R~ESlDENT (If ~if~r~rom above) PHONE 2~ BUYER PHONE MAILING ADDRESS 3. L~NDING INSTI[UTION .... ' PHONE MAI'LING AbD~ESs ....... / - PHONE 4. REALTOR/AGENT MAI LING ADDRESS 5. LEGAl, D F?SCRIPTLON I ST EET,OC O. I 6. TYPE ~F RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four -~lj~ Two [~] Five [] Three [] Six [] Other 7. WATER SUPPLY I~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** ~,/ -*t~'~'?~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ?,,ok. 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: !,'c~~t~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ~;~]~PPROV ED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED~ DATE BY ~