HomeMy WebLinkAboutFISCHER BLK 1 LT 3B7A Onsite File
Fischer
Block 1
Lot 3B7A
PIb# 015 - 292 - 44
** The existing crib may be within 100' of the wells
across the street to the east.
S"07".1 1 /�►L
uLL 112018
Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171375 PID Number: 015-292-44 ❑ New ✓❑ Upgrade
Name:
RALPH & MARY UNDERWOOD
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
5141 SPRUCE CREEK CIRCLE
❑ Other
Phone
Number of Bedrooms
Soil Rating 1
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
FISCHER 1 3137A
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Fl.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
102.3
N/A
N/A
N/A
99.8
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
I 1000Ga1.
Surface Water
100+
N/A
N/A
N/A
Material
Number of compartments
Lot Line
21.5
N/A
N/A
N/A
STEEL
2
NA
Foundation
7.0
N/A
N/A
I N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
N/A
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
SCOTTS SERVICES
Drainfield CO/MT 3034
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) 433.Oft
Inspection,,
1/4/18 12/4/18
Location and description
dates: 2"d
3rd 4`h
SW BOTTOM HOUSE TRIM
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF A�
Conditional Approval: Date
��G
'seven • �onnone•�
Pk_tLCCA LC�VJJ
LCE 8149AW
,W
..
Approved Date 1
ROrCJJ�`�' {( p�
ll ' 4
inspection Neport_i-i-iz.00c
3A
--
0' Ut'l Esmt
WELL E)
WELL E'
440
387;
365
3 HDR
SFD
A K REMOVED 1000a SEPTI(
PER MOA CODE
DRAIN FIELD E� .04
W C0L,
SEEPAGE PIT (E).-
z
SPRUCE CREEK-, Cir
B4
w
vi WATER LINE /
B
TI
—A
2.8
8,6
T2
9.0
11.3
DC
12.8
12.4
DC2
1 13.3
12,2
w
vi WATER LINE /
WELL RADIUS
Ss
Ss NEW SEPTIC
20
0
D
Li
z z
<
mz
<
ABBREVIATIONS
Z) W
0-
TH
TEST HOLE
433.0
(P)
PROPOSED
(E)
EXISTING
CO
CLEAN OUT NO.
42
FC
FOUNDATION CLEANOUT
FS
FLOW SPUTTER
1000gSEPTIC
MT
MONITOR TUBE NO.
g
TANK
TYP
TYPICAL
PROFILE
SCALE: NTS
NOTES: PANNONE ENG SVC, LLC Date
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 12/14/18
PHONE (907) 272-8218 FAX (907) 272-8211 Scale
F== 1" = 50'
FISCHER Bl L3B7A ....... P.I.D. NO
1015-292-44
RALPH & MARY UNDERWOOD A: bnnone
DRAWN=:= ACP CE 8149 PERMIT NO.
5141 SPRUCE CREEK CIRCLE OSP1 71375
ANCHORAGE, AK 99507 Sheet
2 OF 2
oToTzfr MUNICIPALITY OF ANCHORAGE scentS,On-Site Water&Wastewater Program _° ^,�PO Box 196650 4700 Elmore RoadAnchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.orglonsite '
Dchirlink III
h�H'�gp6'
On-Site Wastewater Disposal System Permit
Permit Number: OSP171375 Effective Date: 12/22/2017
Work Type: SepticTank Upgrade Expiration Date: 12/22/2018
Tax Code Number: 01529244000
Site Legal Address: FISCHER BLK 1 LT 3B7A G:2537
Site Mailing Address: 5141 SPRUCE CREEK CIR, Anchorage
Owner: UNDERWOOD RALPH W & MARY A Lot Size in Sq Ft: 11662
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
/ / ' // Date: 2/.a1 7
Received By: .-k01 - .__i
Issued By: hi,./,if/!rt/V Date: I Z�/
-e\r)( V_-eFtC\-i I
0
MUNICIPALITY OF ANCHORAGE
70
Phone: 907-343-7904_
Community Development Department Fax: 907 43-7997'
Development Services Division 77
On-Site Water & Wastewater Programr\i A
ON-SITE SEWER/WELL PERMIT APPLICATION DEC L 1 2017
a
ikidar ,,,\, '
Parcel I.D. 015-292-44 c, h
ane
Property owner(s) Ralph Wayne Y & Mary Underwood Day phone - g i,°'
Mailing address 5141 Spruce Creek Cir. Anchorage, AK 99507
Site address 5141 Spruce Creek Cir.
Legal description (Sub'd., Block & Lot) Fischer Block 1 Lot 3B7A
Legal description (Township, Range & Section)
Lot Size 11,662 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply) — Single Family (SF) X
Absorption Field H Initial — (w/wo ADU)
Septic Tank 0 Upgrade 0 Duplex (D) n
Holding Tank ❑ Renewal ❑ Multiple Dwellings H
Privy _ (SF and/or D)
Private Well ❑
Water Storage H
THIS APPLICATION INCLUDES A VARIANCE /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)
Permit/Rush Fees: 9,/5 Waiver Fees:
Date of Payment: /a11f Date of Payment:
Receipt Number: 00/0!0(. Receipt Number:
Permit No. (35P(343-4"6 Waiver No.
Permit App_:-:• .--•,:c=
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve(u)panengak.com
December 21, 2017
Subject: Fischer Block 1 Lot 3B7A - Emergency
Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1,000g Septic Tank to replace an existing
1,000g Septic tank to be issued for this property. The existing tank has completely collapsed. It will be
decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement
1,000g septic tank that will be connected to the existing drain field. The existing tank is located
approximately 95' from the well. The proposed tank will be placed outside the existing well radius. All
required separation distances will be met.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+ from any property line, building foundation or drain field
10'+from any water line
100'+ from any surface water
100'+ from any private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincerely,
•44-S
• Steven R.Pannone
‘.111.0kj
••" °• CE 8149_\ elf>,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
~ MUNICIPALITY OF ANCHORAGE
D. ~RTMENT OF HEALTH AND HUMAN SEk .~ES
Environmental Health Division
., 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
' ~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCES
~=o,~ ~FROM ~TO SEPTIC ABSORPTION
WELL
~ fY I ~p,.-,'.ce c/,-,- I,~.
TANK
FIELD
~.?~ ~/~71' ~-o~eZ ILOTLINE
TANKS O '~ N
~ TRENCH ~ED ~ W. DRAIN ~ OTHER
. ,du,
6-~Z SOFT -~ ~o ~ ,.
?- 1oO SOFT F ~O ·
'~1
WELLS ~
REMARKS:
Inspechons Pedorme~ by
A~c5 /n~ ~/~"~ '. ". ....
J~/~ ~/_~., ~ 0 --7~~ Date.
Hea[~[Depeffment APprOv~1 -- '
72~13 (3~85)
MUN I~C I ~AL I TY OF ANCHORAGE
DEPARTMENT OF~ HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE~ AK 99501
264-4720
ON--SITE ,SEWiR PERMIT
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
850582 -ENGINEERED DESIGN
07/02/85
MARTHA A. DEARBORN INC.
5141 SPRUCE CREEK CIRCLE
ANCHORAGE, AK ~516
277-4675
LEGAL DESCRIP:
LoT SIZE:
SECTION: 15 TOWNSHIP: 12N RANGE:
20000 (SQ. FT. OR ACRES)
~LOCK: I
certify that:
1. I am familiar with the ~equirements for
5.
on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
I will install the system in accordance with all MOA codes and regulations~
and in compliance with the design criteria~of this permit.
I will adhere'to all MOA and State of Alaska ~equtpements for the set back
distances fpom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent o~ nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
Department of Health and Human
Services
825 L. Street
Anchorage, Alaska 99501
Attn: Robbie Robinson
JUN 1 9
RECEIVED
Dear Robbie:
This is in regards to Fischer Subdivision Block 1, Lot 3B7. AECS
recently performed a soils test on this lot for the purpose of upgrading
the septic system, ~aich presently is not working and has to be pumped
once a month. The soils encountered were an excellent clean sand and
gravel rated at 100 square feet per bedroom, but there is a water table
at 10.5 feet. Due to the locatlon of the existing house and septic
system, t~$ only system that could be built ~aile avoiding a llft
station would be a bed.
Unfortunately, there is not very much ~oom-on-the-lot'~--NThe.mraer would
like to have the system designed for ~ 3.__-bedro. om ho~e,~maklng the .
system as large as possible. Attached~l~W-dlaL,~ showing the location
of the existing septic system and well and the area available for the
proposed new septic system. We are requesting a waiver of two lot lines
in order to get the system ~n, the south lot line, which borders the
road, and the wes~lot llne. ~hich borders an adlolnln= lot. The new
septic system would not influence lots to the south because the wide
road is there. It would also not influence the neighboring lot to the
west because it is only a bed, and the system's lateral influence wiII
be very small. Normally the distance between parallel beds on a lot
needs to be 6 feet to avoid cross-contamination. In this case, we are
requesting that the distance to the south and west lot lines be waived
do~n to 5 feet. Even if the neighbor to the west needs to upgrade, the
new system on Lot 3B7 will be far enough away not to damage their soils.
At present, the system of this neighbor lot is way on the other side of
their driveway. Also, the proposed new septic system will be over 100
£eet /rom all yells.
If you have any questions please feel free to call our office at
561-5040.
Sincerely,
~-O~' /Z,~. ~ .~Da~c~,~e.venSEng,neer~ng Geologist'
Approved by:
" l~O ~¢Sl 33r~ ~uenue Suilt ~* ~nch0raqe. ~las[a 99503 *(907) 561-~0
ALASKA ENVIRO~NTAL 8.[~.o. ~ o~
CONTROL SERVl S, INC.
1200 West 33rd Avenue, Suite B CALCULATED BY ~ ''? OATE
ANCHORAGE, A~SKA 99503 C.ECK~O BY. DATE
(907) 56[-5~0
ALASKA ENVIRO~[NTAL ..~.o ~, o,
CONTROL SERVI( ;. INC.
1200 West 33rd Avenue,Suite B CALCULATED BY ~' ' '~ DATE
ANCHORAGE, A~S~ 99503 c.~c~eo ~Y DATE
(907) 561'5~0 ~,. ~ /~ ,
SCA~E
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 t.. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
SO,LS
[] PERCO.AT,O.
TEST
PERFORMED FOR: ~.,~15 ~'¥cnv.~.'tt-/.~·
DATE PERFORMED:
LEGAL DESCRIPTION:
2
8
SLOPE
SITE PLAN
10-
11
13-
14-
15
16
17
18
19
20.
WAS GROUND WATER
ENCOUNTERED?
IFYES. ATWHAT IOl'Z. art
DEPTH? t ~)l~Z*. o,/ 6-
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
PERFORMED BY: ~,~ ~o~ ~- o2~ CERTIFIED BY:
724)08 (6/79)
GRE/' R. ANCHORAGE AREA B01r'"'" 'GH·
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ,~a~'o~'~.tO~x] C~r. MAILING ADDRESS z~ /~/ E. 5',,~~ PHONE
LOCATiON.-~p~UCg ~'~- ~,~:~. /,~Z. lX/,~I..E/2., LEGAL DESCRIPTION /-.07"
SEPTIC TANK:
DISTANCE
FROM WELL //J"~
INSIDE LENGTH
MANUFACTURER ,..~7'-~9~,~_
INSIDE WIDTH
NUMBER OF
MATERiAL~//~//o~.r i~1/ COMPARTMENTS
LIQUID DEPTH
I IQUID CAPACITY /~"P-'~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER OR WIDTH /.F~ LENGTH /~,! DEPTH ~-
LINING MATERIAL[O~'J' (~d. CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM:
TOTAL EFFECTIVE
BUILDING FOUNDATION /¥.~,,I/'*J- NEAREST LOT LINE.~''~! ABSORPTION AREA (WALL AREA)
/,~, /
WELL / ~ ~ I
~d .SQ. rr.
ADDITIONAL ABSORPTION
WELL:
TYPE ~0///.
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION ~'! ~II~FZ) DEPTH
NEAREST I NEAREST SEPTIC
LOT LINE ~0 SEWER LINE TANK --
OTHER SOURCES
DISAPPROVED. REMARKS
DISTANCE FROM:
SEEPAGE ,/~ ·
SYSTEM .
DISTANCES:
INSTALLED BY:
PiPe MATERIAL:
LOT SLOPE:
REMARKS:
Fo~m No. EQ-031
DIAGRAM OF SYSTEM
APPROVED~...,,.~-...,.~ ~.. ~c~/'../4.~hU' '
G.A.A.B.
grEaTEr aNCHOrAgE aREa bOrOUgH
pERMIT NO.
PHONE
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
TYPE AND SIZE OF FACILITY TO BE SERVED
SOIL TEST RESULTS //~t-~ ~/ ~'~
COMPLETION DATE ANTICIPATED
/
PINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
D£PARTMENTOF ENVIRONMENTAL QUALITY AUTHORITY WILL laESUBJECT TO PROBECUTION.
MINIMUM DISTANCES. Rr'QUIREM£NT~
FOUNDATION TO SEEPAGE PiT
/
5"/
WELL TO
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
·
DRAIN FIELD
DRAIN FIELD
DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
GRAVEl. DACKFILL
CONFORM TO I~IOROUGH REGULATIONS REGARDING INSTALLATION,
SEEPAGE AREA SIZE TYPE
DIAGRAM OF' ~ySTE:M
II
~' ~' ~-/ I II
'Ill
I1',
I'
· F' ?o~tor~e~ For
':.<.'L~a~,l .QoscrSn'tion: Lot. ,~'/~l)lock..7 .Subdivision /c'l~x/~'~-
..',..':,,,.,Th:s form Re~orts Soils Lo.q ,~es Percolation Test
6--
7
8
9
Eldon. Peddereon Date Performed
Sot1 C~aracteristtcs
overburden .'
Coarse ,G, ra~cg'l,'..'grade OW;O? {8~ :
. .__
I--
,¥ ~a.ndy'.Oravel, graded OW-GM
~ (18o)
1(1 Silt with ~o~w'~'* Graded FLL
"12 feet bottom of test pit
,__ Was Ground IJater Encountered? No
If Yes, At What Depth?
:i
Data Certified By': Construction Te~,
Date: L~-11-74
i;i.:Perco'lation Rate Minute
· '. ' Proposed Installation': Seeoace Pit ~es Drain Field.__
.'.:'.'. Oecth of Inlet Depth To Bottom Of Pit Or,Trench
~-:'C~MP£1ITS: 100 sq. re. arainage area required.per bedrqom from -2' ~o
"-' ~o bedroc~ or water table to minus 12 fee~
,.. ~cst Performed By Jim Mack
-' -~'' · · ~ab Manager
.Reading Date Grnss Time Net ~tme Depth to H20 Net Drop,
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE ~.
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
.r.
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lo+
Location (address or directions)
(b) Property owner
(C) Lending Institution ~/~ Telephone ~/~
Mailing Address ~/A
(d) Real Estate Company and Agen, ~~'~t( B~.~'~ ~
Telephone ~ J - ~
(e) Mail the HAA to the following address: (or check here ~d for pick up.)
List contact person and day phone number below:
2, TYPE OF RESIDE,..N. CE
Single-Family ~ Number of bedrooms
3. WATER SUPPLY~
Individual Well I~' Community r'l Public
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE .~OSAL
On-site ~ Public [] Community I-I Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional end 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 ~gulations in effect on the date of this inspection.
6. DHHS APPROVAL
Approved for, ____bedrooms by ' Oate//--
Approved X Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph $ 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·
· ;'2.0~(R.~.?/~)a,c~ Page 2 of 2
ENVIRONMENTAL SiC. ViCES ~
6CT O' 1.989
RECEIVED'-
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY1984 ..
.. 343-4744
Legal Description:
~ ' If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)~J Date Completed ~' Yield ~'()~pi'vt
Total Depth~c)i ~ased to' Z~'l~)l']' Depth of Grouting (,/~ ~ c:'JJY'I'
Static Water Level ~.- ~-'~ (~ "~, Pump Set At
Casing Height Above Grouted · ~ I'~il Sanitary Seal on Casing (Y/N) {T~
Electrical Wiring in Conduit (Y/N) . I.~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~; On Adjoining Lots ~ Io(:~:)
To Nearest Edge of Absorption Field on Loi I J O j ~"': ; On Adjoining Lots
To Nearest Public Sewer Lin~ /")/~[' To Nearest Publi(~ Sewer Cleanout/Ma'nhol~
To Nearest Sewer Service Line on Lot ~. ~ ~:) I
Water Sample Collected by
Water Sample Test Results
Comments ;,'~.r ~~[p~(
, Date .
B. SEPTIC/HOLDING TANK DATA
Date Installed ~Size [~ C::~ No. of Compartments ~
Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~
Depression Over Tank (Y/N) ~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~,U/,z~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well i C) ~ ( '~"~ TO Building Foundation
Foundation Cleanout (Y/N)
Date Lest P~mped ~
t,5/,,~-- ;for
Temporary Holding Tank Permit (Y/N)
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments '/~ PO,{- ~/~utl'~_l"'D~.(
r._ ....
,/
To Disposal Field ~ lot
Page I of 2
Square Feet of Absortion Area
· Depression over Field (Y/N)
Results of Last Adequacy Test
-~ '~"~£ -~' Statndpipes Present (Y/N)
~ Date of ~ast Adequacy Test
.C. ABSORPTION FIELD DATA (
Soils Rating In Absorption Strata I~) ~) I~.YMr~ T~'p(~ of System Design
Date Installed ~ Length of Field
Width of Field J~' ~ ~J ~ ~ Depth of Field
: ~ ,, Gravel Bed Thickness
sEPARATION DISTANCE F, ROM ABSORI~TiON FIELD:
TO Water-Supply Well I ! ~) .~t,~ .
To Building Foundation ' ~- 0~ ,~
Lot ~ ~ I ; On Adjoining Lots
TO Water Main/Service Line '~' ! O ~ To Cut~3ack (if present)
To Stream, pond, Lake, or Major Drainage Course ~//~-
To Driveway, Parking Area, or Vehicle Storage Area · I ,,
Comments ~ Dg_~l- ~,~.CLVt~'~.~'"D~LI. ~-.~__~"~'~:~
T oPropert~,_Line ~ ~ f ~
To Existing or Abandoned SyStem on
D, LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes
Comments
* Di~e~sions'
Manh'oie/Access
Vent(Y/N)
Pumping Cycles during Adequacy Test.
**Check Perg{~ted Bedroom/ating Against HAA Request** ' '
I certify th4~(~ :ke]~-e-e~ied. or conformed t~ all MO~A an HAA the date of this
inspectio~f////~ // / ; ..,,
Signed ! ./,/./~l~,4,, / ~
Compan~ U~.~ L~.~"~. I,~.
Date ~0/ ~(~:~ / Engineer's Seal
MOA NO. ~ '~-"'1 ~
Receipt No.
Date of Payment
Amount: $
,,~ujdel~ ~n .effect on
Receipt No ' ' ~'~
Waiver Fee: $
Date of Payment
Page 2 of 2
GREATER ANCHOILAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection ~.~
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval'requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location: .~v~ ~.~
5. Type of facility to be inspected
6. Well Data:
Phone:
A. Type
e
. Phone:
No. of bedrooms
C. Construction ~.X>ae$~qm~
Sewage Disposal System:
C. Septic Tank: 1. Size /o~ ~£. 2. Manufacturer..S/~z
D. Seepage Pit: 1. Absorption Area 35d~ 2. Material
E. Disposal Field: Total length of lines ~
B. Depth 2~i
D. Bacterial Analysis
Distances:
A. Well to: Septic tank
Nearest lot line ~
B. Foundation to septic tank 3'
C. Absorption area to nearest lot line
~ , Absorption area /d
,, Sewer Lines
Other contamination
~, Absorption area
EQ-034 '(1/74)
Page 1 of two pages
,Page 2 of two pages - Re/~ ]st for Approval of Individual ?'~ler & Water Facilities
'L~gal Description
Comments
Approved
/~.~ ~r~ Disapproved. Date
Approval.Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
WATER QUALITY SECTION
CASE NUMBER:
S-8899
SUBDIVISION OR PROJECT TITLE:
T.ot
CASE REVIEW WORKSHEET
DATE RECEIVED:
January 2, 1990
3-B-7 Fischer Subdivision with Vacation
ICOMMENTS DUE BY:
January 22,
1990
PUBLIC WATER AVAILABLE
COMMUNITY WATER AVAILABLE
COMMENTS:
) PUBLIC SEWER AVAILABLE
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
E]~/IEOHMI:HI-At. rK',.;I CCI
VACATION OF R;GHT-OF-WAY OR OFFICE USE ~'....-.
· * ' EASEMENT APPLICATION *
Municipality of Anchorage . RECD a~. ·''- ~ '*"
DEPARTMENT OF COMMUNITY PLANNING V~q~Fy OWN~., -; :- -,-' -"
. . P.O. Box 6650
Anchorage. Alaska 99502-0650 .... ~ .- *-
Please fill in the information requested below. Print one letter or number per block. Do not write In the ~haded blocks. -
0. Case Number ('iF KNOWN) 1. Vacation Code
IIIIIII
2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET) /~)
I°1 1
Exlating abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34).
4. Petitioner's Name (Last- First)
Address .~ 7~"~ r,"~o '~
City ,,~/f/'E,,~'~,~-~'~" State
Phone No. ,~/7/ /Q :" .,~,~'/-, ~ Bill Me
5. Petitioner's Representative
II
Address //C~/~ '~ ,;,4'fo,,"/'~)
City '"~"//'/""~/~"~4;~'*~' State
Phc~ne No. _~'-C, 7--- ,,~' Bill Me
6o
Petition Area Acreage 7. Proposed Number 8. Existing Number
9. Traffic Analysis Zone
10. Grid Number
I I:1:1 1:1 1
S 8899 FEB 0 '7 1990
12. FeeS .
13. Community Council
Date:~
I hereby certify that (I am) (I have been authorized to act for) the owner of the properS/described above and that I desire to
vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I'understand that payment of
the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does
not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's costs to
process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have
to be postponed by Planning Staff. Platting Board. Planning Commission. or the Assembly due lo administrative reasons.
Signature
'Agents must provide written proof or authorization.
C. Please check or fill in the following:
1. Comprehensive Plan -- Land Use Classification
~/ Residential
Commercial
Parks/Open Space
Transportation Related.
2. Comprehensive Plan -- Land Use Intensity
Special Study
3. Environmental Factors (if any):
a. Wetland
1.' Developable .
2. Conservation
3. Preservation
Marginal Land
Commercial/Industrial
Public Lands/Institutions
Dwelling Units per Acre
Alpine/Slope Affected
Alpine/Slope Affected
Industrial
Special Study
b. Avalanche
c.. Floodplain
d. Seismic Zone (Ha'ding/Lawson)
D. Please indicate below if any of these events have occurred In the last three years on the property.
Rezoning
Subdivision
Conditional Use
Zoning Variance.
Case Number
Case Number
Case Number
Case Number
Enforcement Action For
Building/Land Use Permit For
E. Legal description for advertising.
7
F. Checklist Waiver
30 Copies of Plat
Reduced COpy of Plat (8'~ x 11)
Certificate to Plat
Fee
Topo Map 3 Copies
Soils Report 4 Copies
Aerial Photo
Housing Stock Map
Zbnlng Map
Water.
Sewer.
Private Wells
Private Septic
Community Well
Community Sys.
Public Utility
Public Utility