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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 Wastewater Disposal System Permit
Permit Number: OSP211391
Work Type: Septic Upgrade
Tax Code Number: 01840130000
Site Legal Address: DEARMOUN #2 BLK 2 LT 1 G:2935
Site Mailing Address: 3600 MATTHEWS DR, Anchorage
Owner: PORTER THOMAS J LIVING TRUST
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
��enr
G Vii.
1_)epa rtinent
9/15/2021
9/15/2022
11915
Q Disposal Field Q 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:
1. The contractor shall locate the water service line to verify minimum 10 ft separation to the septic system (AMC
15.65.205B.1.b & 15.65.21013.1.j). The water service line location shall be shown on the final record drawings.
2. The existing absorption field is located less than 10 ft from the north and east property lines (AMC
15.65.210B.1.h) and within the 10 ft utility easement. Prior to final inspection report approval, a waiver and
j Right -of -Way Encroachment permit shall be obtained.
Received By: Date:
Issued By:Date:
U BUPAUTY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
On-Site Water &Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
'/Parcel I.D. 018-401-30
Property owner(s) THOMAS PORTER LIVING TRUST
Mailing address 3600 MATHEWS ROAD *ANCHORAGE, AK
Site address 3600 MATHEWS ROAD *ANCHORAGE, AK
Day phone 602-725-1948
Legal description (Sub'd., Block & Lot) DEARMOUN #2; BLOCK 2, LOT 1
Legal description (Township, Range & Section)
Lot Size
Sq. Ft. . Number of Bedrooms 2
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
7
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
0
Upgrade 0
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(Sr and/or D)
Private Well
❑
Water Storage
❑
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 at t orized ag nt _
Permit/Rush Fees: 14 5 9 5 Waiver Fees:
Date of Payment: 9 y A I Date of Payment:
Receipt Number: D-] S q0G Receipt Number:
Permit No. O 5P.2 1 13 i l Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Clie nt Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211391, Rebecca Carroll, 09/15/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211391, Rebecca Carroll, 09/15/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211391, Rebecca Carroll, 09/15/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211391, Rebecca Carroll, 09/15/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211391, Rebecca Carroll, 09/15/21
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72-013 (Rev. 3/78) /
( MUNICIPALITY OF ANCHORAGE
i
�\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
1
ENVIRONMENTAL ENGINEERING DIVISION
' 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
\'
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMEHONE
NEW
BOBf AU E-133—
MUPGRADE
MAILING ADDRESS
*78-5 IC C12CL r= ANCH 99 0-7
LEGAL DESCRIPTION '
L,o 7 I Bk " 00 IQ
LOCATION
NO. OF BEDROOMS
Co CN la IL DMAIIMnowX1&5
2
Well
Absorption area
Dwelling
PERMIT NO.
U
DISTANCE TO:
/L
ilJOl
Y
EZ
W fa
Manufacturer `
Mates IT G L
No. of com�,aoe
W
h
Liq. capacity in gallons
/0.es.
IF HOMEMADE:
Inside length
Width
Liquid depth
f3 Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JVZ
_? F
Manufacturer
Material
Liquid capacity in gallons
O
W =
DISTANCE TO:
Well
Lo N T ♦
Founday ,on
G63$�
Nearest lot line
PERMIT NO.
W M O
w
No. of lints
Len th of a ch line
g Z;
Total leng'f t� pf lines
Trench width
Distance between lines
f 2
/
Inches
��•
QF
Top finish
Material beneath tile
Total
C
of the to grade
Go
effective abs prion area
V
t. /= %
inches
O
Length
Width
Depth
PERMIT NO.
W
Q1— '
Type of crib
Crib diameter
Crib depth
Total affective absorption area
a a .
W
y
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W 3
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
u �O
�
D -3o3
SOIL TEST RATING
INSTALLER
sMAPIT
N
REMARKS
Cd Qr
t�• OF Ajfr Vit,
..• .. ..
NE 25, 1911 ✓
1+�1ss/o...........
Crib
D V
o K o zL •2
LEGAL p,`' `/ fp`nI
APPHOVEDo,�+ /J D/A�J,E
D_e 41r
t/ ;t4 0 H
72-013 (Rev. 3/78) /
r1 x SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �d� HAIJE IZ DATE PERFORMED: 3.2/. & y
p q TlUt
�
LEGAL DESCRIPTION: I_ C�`I'• A Lo L (L Z. b E A2 H n u N z SEC;z9 Q 3 w
]&Vjljrj SIL.Ty GRAVI_ L
'
10i10 GM
2 ,p
3-
0 e
,tt.r
5-
6-
7-
8-
9-
10-
I,' 67 8 9 10 17
I
12 1(f'�
ISI �
13
Se4f4oY GruvF-L-
CP
r•NE SONO
sP
150
OF A(�Al
•2225-E
E 25. 1971
WAS GROUND WAT R \t O
ENCOUNTERED? LO
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE I5Q VISUAL (minutes/inch)
TEST RUN BETWEEN —1-4— FT AND I3 FT
PERFORMED BY: � . S CERTIFIED BY:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
y DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
Ot,J—S~ I TEEWER PEmM I T �r
PERMIT 140: 840118
DATE ISSUED: 04/02/84
APPLICANT: BOB SAVER
ADDRESS: % 203 W. 15TH
ANCHORAGE, AK 95503
CONTACT PHONE: 279-3916
LEGAL DESCP.IP: SUBDIVISION:
DEAMOUND
LOT: 1
BLOCK: 2
SECTION: 28
TOWNSHIP: 12N
RANGE: 3W
LOT SIZE: 1191(S. FT. OR ACRES)
MAX BEDROOMS: ,2- ort � �
LISTED BELOW AR HE OPTIONS
AVAILABLE TO YOU
IN DESIGNING
i
YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THAT
BEST FITS YOUR,
— —
SITE.
—
— — — — -
- — — — — — — — - — — — — —E
TFZt•aCH
E:EE: E>
W 0, FR F=l I til
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
4.0
3.5
GRAVEL DEPTH (FT.)
5.0
0.5
7.5
TOTAL DEPTH <FT.)
9.0
2. 5
4.5
19. 0
5.0
GRAVEL WIDTH(FT.)
(FT.)
��
36.0
49.0
GRAVEL _LENGTH
,30�
25.3
36.2
GRAVEL VOLUME (CU. YDS.)
22.9
11 000. 0 »:y:
11000.0 **
1,000.0 *»°
TANK SIZE (GALS)
SOIL RATING (SG. FT. /BR)
150
150
150
— ** TANK MUST—HAVE AT—LEAST—T410 COMPARTMENTS — — — — — - — — — — — — — — — — —
I CERTIFY THAT:
1. I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND.WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOR) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IM COMPLIANCE 14ITH THE DESIGN CRITERIA OF THIS PERMIT.
.3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK,
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE'SYSTEM ON THIS OR ANY ADJACENT OP. NEARBY LOT.
4. 1 UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR 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 <3) THE
ELECTRICAL WORK MUST BE DONE BY A LICEI9ED ELECTRICIAN.
SIGNED DATE:
-----—
APPLICANT: BOB RAVER
ISSUED BY ,r/�f DATE :
---�-1 -'-`=";"-- ---------- -y�` -- e. 3,6A2
r..
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIROM4ENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date 5- 7.8 Li
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOT I. BK 12, DE AR MOU N SEC a TTiaN,r a
Location (address or directions)
'D(: A R HA u w/ y4 T H M .Vi S
(b) Applicants Name Rn 6 SAL) a Telephcne 3VV- 7Y4O
Applicants Address 7e S / kf1A Illi i CIPL.
(c) Applicant is (check ore) Lending Institution Owner/builder ;
Buyer ; Other Q (explain); /
(d) fending institution Ci ra%I, N. Y- �3e"P-k Telephone -378'D
C)
Address Ego>C 7A A►, L•4 Ale-
(e)
le-
(e) Peal Estate Co. & Agent HAV -5,10N. V,1 VA RO P-0 0 4 019 aHfS
Address Wo -g / LJrH Q 9Q N !1 g 6-0 3
Telephone a 1/R • / %! 7
2. Type of Pasidence
Single -Family nzr Multi -Family
Number of Bedrocnn f,-
3. Fater Supply
Other (describe)
Individual Wbll Community � Public
Note: If o=wnity well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the rw ber of bedrooms specified in this HAA (YIN)
4. Sewage Disposal
Onsite
M
Public
community Q
Holding Tark
Is the
wastewater disposal
system adequate for
the number of bedroom, (Y/N)
[Page 1 of 21
2-15-84
n
5. Engineering Firm Providing Inspecticrs, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MDP, HAA Guidelines in
effect on the date of this inspection.
Signed
Nam of Firm 1 "o b b .e H ->o o V
Signed by 0 a �i�i-s-��e q.N%�-
Date Yee -7 C g y
(ENGINEER SEAL)
6.DHEP Approval
Approved for _ bedroams
Approved G Disapproved
Terms of Conditional Approval
Date rt g
nee x'79- 39/.6
y�P��
n� X146. 2225-E
v Conditional
Date411
The Municipality of Anchorage Department of Health aril Ervircxmental Protection does
not guarantee Un continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
ticral for the number of bedreans and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
(Page 2 of 21
2-15-84
kr.r,"PALITY OF ANCHORAW
DEPT. OF HEALTH &
cn+.90NMENTAL PROTECTION
MAY 71984
RECEIVED.
A. WELL DATA
ra
MUNICIPALITY OF ANCHDRAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST_- FEBRUARY 1984
Legal Description:.
Well Classification. $ If A, B, or C, D.E.C. Approved(Y/N) tJ �
Well Log Present (Y/N) z Date Completed ? Yield Z
Total Depth Z Cased to Z Depth of Grouting 7 -
Static Water Level Z Pump Set At 7s
Casing Height Above Ground Sanitary Seal or. Casing (Y L)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (YM)
Separation Distances fran Well:
To Septic/Holding Tank or Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ;
To Nearest Public Sewer Line
On Adjoining Lots
To Nearest Public Sewer
Cleancut/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected By Date
Water Sample Test Results
Camrents
B. SEPTIC/HOLDING TANK DATA
Date Installed 2 /8 Size 100G No. of Compartments
Standpipes (Y/N) 7 Air -tight Caps (YIN) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) N Date Last Pumped
Pumping/Maintenance Contract on Fits (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well C..Nw•«.� 7&6o To Building Foundation Z.
To Property Line {j To Disposal Field 5
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course
Comments
[Page 1 of 21
2-15-84
Soils Rating in Absorption Strata Type of System Design 7M44 e.�
Date Installed �,�/e y Length of Field yj I
Width of Field Depth of Field f Z)
Gravel Bed Thickness S 4F
Square Feet of Absorption Area o Standpipes Present (Y/N) Y
Depression over Field (Y/N) Ij/ Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance frac Absorption Field:
i
To Water -Supply Wall 7 ao To Property Line
To Building Foundation d To Existing or Abandoned System on
Lot y0 t On Adjoining jots yo 1'
To Water Main/Service Line VNO I N "iso Cutbank (if sent)
To Stream/Pond/Lake/or Major Drainage Carie
To Driveway, Driveway, Parking Area, cc Vehicle Storage Area �y b
Comments * Uo rz p- T*Aiq t o F�i .
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MDA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, cc conformed to all K
on the date of this inspection.
Signed Date
Comgany MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
U n I I E OF
'[�1US98
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONNMENTALL CONSERVATION r ievnone.1907)
Address:
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200 274-2533
ANCHORAGE, ALASKA 99501
PWS I.D..I a 114 3G,
To Whom It May Concern:
According to records on file in this office the Hnwo-
cCIIR � ) Th/JJ Tho Water System is in compliance with the State Drinking
Water Regulations.
Sincerely,
94