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Home My WebLink AboutDALZELL-SCHNEITER BLK 2 LT 18 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251281 PID Number: 015-291-30 Dwelling: Z Single Family (SF) M with ADU 171 Duplex (D) M Two Single Family Project: El New Z Upgrade Name THOMAS & NANCY LAMPMAN ABSORPTION FIELDS - EXISTING M Deep Trench El Wide Trench E] Bed M Mound Site Address 10151 EVERGREEN TREE STREET, ANCHORAGE El Other Phone Number of Bedrooms Soil Rating depth from original grade 1 4 GPD/SF ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot DALZELL-SCHNEITER 2 18 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. 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 2 Ft Ft. Well 100'+ 25'+ TANK Z Septic C1 S.T.E.P. [I Holding El Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ Material HDPE Number of compartments 2 Lot Line 10'+ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. Deep-burial septic tank. Alarm location Electrical installed by Tankto PIPE MATERIAL House to tank 3034 drainfield 3034 Installer NORTHERN EXCAVATION Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 8/28/2025 nd9/2/2025 Location and description dates: 2 V 4tfi MANHOLE TOP ON-SITE WATER AND WASTEWATER SECTION APPROVAL At. Conditional Approval: Date AW A TH • .. .. .... ........... W, Curlis Septic System Approved 7_--->. Dateq�ds Huffman CE 128991 .99/02/25. X� Note: this approval does not include well permit requirements. NN,PROFESS00- (Rev 05/02/18) PID:015-291-30 PERMIT:OSP251281 FIRST WATER CONSULTING DALZELL-SCHNEITER B2, L18 Docusign Envelope ID: 5E5D2C01-80D8-4417-BF97-D31C75FE591E Docusign Envelope ID: 9400204A-5879-479B-BDE1-E7D250A5CE92 MUNICIPALITY ANCHORAGE c� LPG Development Services Department q Right of Way Section Departmctir ENCROACHMENT PERMIT R251936 THIS AGREEMENT, made this 2nd day of September, 2025, by and between Thomas & Clancy Lampman and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: DALZELL-SCHNEITER BLK 2, LT 18, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The 10' UTILITY FOOT RIGHT OF WAY OF EASEMENT, immediately on the northeast side of PERMITTEES property as shown on Plat No. 77-250, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a leach field standpipe upon the referenced real property which encroaches 1 feet upon the PERMITTER'S 107 utility easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: The PERMITTER, acting through the Director of Development Services Department; hereby grants to the the the privilege of allowing the leach field standpipe to encroach I feet upon the PERMITTER'S 10' utility easement, as shown on "Attachment A," included herewith. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching leach field stand pipe, as placed upon the PERMITTER'S 10' utility easement. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing_ the approval of the Director of Development Services Department. Docusign Envelope ID: 9400204A-5879-4798-BDE1-E7D25OA5CE92 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE_ The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 10' utility easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, Without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: Deceased Thomas Lampman — Owner Signed by: BCV9067B76436... Nancy Lampman - Owner GRANTOR: MUNICIPALITY OF ANCHORAGE John Snelson Right of Way Supervisor August 29, 2025 Thomas Lampman 10151 Evergreen Tree St Anchorage, AK 99507 To whom it may concern, Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the absorption trench encroachment into existing 10’ Utility easement on the Northeast side of lot located within Section 15, T12N, R3W in Seward Meridian DALZELL-SCHNEITER BLK 2 LT 18, also known as 10151 Evergreen Tree St, city grid ANSW2537, GCI WO# 25- 0002-23. This letter of non-objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair, or reconstruction of GCI’s facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now, and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, ______________________________ Signature ______________________________ Date ALEX SLAVENS GCI | OSP Design Data Management Delivery Engineering 907-868-1049 Docusign Envelope ID: F06A661D-7EE6-4397-A737-611FF4F4E79C DATE: AUGUST 28, 2025 Re: <LEGAL DESCRIPTION OF PROPERTY - LOT 18, BLOCK 2, DALZELL-SCHEITER SUBD.> 1.Alaska Communication has no objection to the encroachment of an existing 4” conduit, 11’ below ground surface into a platted easement located at 10151 Evergreen Tree St, Anchorage AK, as depicted on the as-built drawing submitted. 2.Alaska Communications hereby issues this letter with stipulations to allow the encroachments of the above-mentioned into the 10’ Utility Easement. Acceptance, (your signature below), and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. Alaska Communications will be held harmless, now and forever, for any damage or injury to any person or property because of this encroachment. 2. Any Alaska Communications facility damaged or destroyed as a result of this encroachment will be repaired at no cost to Alaska Communications. 3. Any costs incurred by Alaska Communications for special construction necessitated by this encroachment will be borne by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non-objection will in no way preclude Alaska Communications from full use and enjoyment of its rights within any portion of this easement 6. Alaska Communications is under no obligation to restore any damaged structure as a result of Alaska Communications full use and enjoyment of its rights within any portion of easements or rights-of-way. Please sign both copies, retain one copy for your use and return the other to Alaska Communications. Sincerely, Ricardo Yap Network Engineer III 600 Telephone Ave, Anchorage, AK 99503 (d) 907-564-7207 | (c) 907-230-3666 ricardo.yap@acsalaska.com ACCEPTANCE SIGNATURE: DATE: 600 Telephone Ave., Anchorage, Alaska 99503 tel 907.229.9607 - fax 907.297.3100 www.alaskacommunications.com Docusign Envelope ID: 5E5D2C01-80D8-4417-BF97-D31C75FE591E Aug-29-2025 | 11:04 PDT 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: OSP251281 Work Type: SepticTank Upgrade Tax Code Number: 01529130000 Site Legal Address: DALZELL-SCHNEITER BLK 2 LT 18 G:2537 Site Mailing Address: 10151 EVERGREEN TREE ST, Anchorage Owner: LAMPMAN THOMAS R & NANCY P Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 8/12/2025 8/12/2026 49294 ❑ 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 4 Special Provisions: A ROW encroachment permit and LNOs must be obtained for the disposal field in the utility easement submit with Inspection Report. Received Issued By Date: 8/12/2025 Date: 8/19/2095 MUNICIPALITY OF ANCHORAGE Development Services Department F Phone: 907-343-7904 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1. D. 015-291-11 Property owner(s) JANNA & PATRICK BEASLEY Day phone Mailing address 5640 MILROB AVENUE, ANCHORAGE, AK 99507 Site address 5640 MILROB AVENUE, ANCHORAGE, AK 99507 Legal description DALZELL-SCHNEITER BLOCK 1, LOT 2 Number of Bedrooms 4 Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable ❑■ APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Disposal Field ❑ Initial ❑ Septic TankX❑ Upgrade X❑ Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: 1224 Waiver Fees: Date of Payment: 0/2_5 Date of Payment: Permit No. aP751 Zb22 Waiver No. May 2025 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! August 4, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: DALZELL-SCHNEITER BLOCK 2, LOT 18 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon deep-burial HDPE tank per the attached design to serve the existing 4-bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for current functionality and future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank or other action may be required. The lot and area are served by private water and any encroaching wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251281, Ben Cogger, 08/12/25 FIRST WATER CONSULTING DALZELL-SCHNEITER B2, L18 DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251281, Ben Cogger, 08/12/25 Municipality of Anchorage Page ' ~/' o! ~" · DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5/J ;~/-/O/~ PID Number: ~/~ "~"'Waslewaler System: O New ~ Upgrade ~'"':' ~/.~ ~, ABSORPTION FIELD Phone: Jgr-- ?r ~ ~ ¢ ¢ a Shallow Trench D Bed O Mound a Oiher LEGAL DESCRIPTION a. e ~.o/sq ~, /~ WELL: D New ~y/~?/H~Q Upgrade ~,~ W'eid ~umps.,.,: F,. TAN K SEPARATION DISTANCES ~p.c U Holding U S.T.E.P. ~lom lank ~ietd Sl~li~ Tenk 5~e~ Ll~s ~ w.,~, /,~/~ JlJ~ f//~ ~1/~ IdA LIFT STATION " ', BENCH MARK Remarks: ~;~ ~ ENGINEER'8 SEAl.. · - ~ .'~j ".~. ~:-:., .:.,....~.,;.~.~). Inspections performed by: C/I&/H~ Dates: 1st O&/d5/~ 2.0 Department of Healt nd Hum~ervices apprCva~ Reviewed and approved by: .... Date: Permit No. of 2 SW 94-0163 ~ Page Municipality o! Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waslewater Disposal System and/or Well Inspection Report Dalzell-Schneiter Lot 18, Blk 2 PID No.: 015-29-130 Legal Uescrlptlon: A-C ll.~ ~ EXISTING 35' TRENCH I ( A-H=30.3 15' DRAINAGE EASEMENT . ~.-}.- { ~-J=77.0 LOT ~7 SCALE' : ; ~ ~ TEST HOLE ~ ~ s ~ MONITOR TUBE ,, : o ? S~ER CL~O~ I~ I I -' ~ + - WELL ~ ~ EXISTING LEACHFIELO ~ ' PROPOSED L~CHFIELD -ELEVATIBNS .. m J .... ! ' ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE I OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940163 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:BOS GREGORY N & OWNER ADDRESS:10151 EVERGREEN ST ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/02/94 EXPIRATION DATE: 6/02/95 PARCEL ID:01529130 LEGAL DESCRIPTION: DALZELL-SCHNEITER BLK 18 2 LT LOT SIZE: 49294 (SQ. FT.) NUMBER OF BEDROOMS: .-~3'THIS PERMIT: .-% THIS PERMIT IS FOR TH-~ CON'kRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. 1 SPECIAL PROVISIONS: ISSUED BY:,~', ~ ~ DATE: Louis Butera, P.E. Registered Civil Engineer May 25, 1994 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Dalzell-Schneiter, Lot 18 Block 2 Narrative Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to soil absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. ~C:\WPWIN60\WPDOC$~1994\94-019A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone {907} 69.1-5195 · Fax {907) 69.1-3297 V~,L ~ ' '~ ~. LOT 13 ~. EXIST. 1250 TANK~ I ~'~'' ' TH ~ ~ VACANT ' LBT 18 , ' ' 15' DRAINAGE EASEHENT . e~,'~.' [ ~~ '' ~DIVERSION VALVE ~EXIST. TRE~H ~ - TEST HOLE ~ · - MONITOR TUBE DETA[L o - sewer cutout + - WELL ~- EXISTING L~CHFIELD - PROPOSED L~CHFIELD NO SURFACE WATER .... ~S[M[NT NO KNOWN CURTAIN DRAINS ~EPTIO ~ITE PLaN OWNER: DOS / SEE ~......~ CONtRACTOr: N/A ~2.¢~ ".~'~ ~o. ~ ~4-o~1 ~Ate: 0~/~4/~1 SCAUe ~" = eO' ~'"'"~~~ ............ j' '~ ".. c~-e~ .." ~. P.O. Bo~ ~73294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTE31 LEGAL: DalzelI-Schneiter, Lot 18 Block 2 ~;1ENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on tile site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate tile nearest lot line position and the location of any easements. TANK 1, The existing hank is to be uncovered to assess structural integrity and replaced with a new 1,250 gallon steel tank to MOA requirements if necessary. If existing tank is utilized, provide lid with pomp-out for second compartment. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed I0' at any point. 4. The effluent line is to be connected to the existing and new trench by means of a Bull Run diversion valve. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface g~ter runoff. 8. Tile septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class 'C' well, or 200 feet to any community well. RECQMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPTtt = I0' GRAVEL DEPTtl = 7' TRENCH LENGTH -- 53' TRENCII WIDTH = 3' SOIL RATING = 0.8 GPD/ft: BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallons Twe,fly-four (24) hours notice reql,ired for all Inspections. C:gWPWIN60\WPDOCS~I994\94-019A.$PC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEERS SEAL) DATE PERFORMED, LEGAL DESCRIPTION:..J~/~ ¢l/'~'e//~- L/.~'/~'.,~ Township. Range, Section: D'E.P T'H~ ~'//,d ~ ~" ''/ ,c;~ ~;l& ~,.,,,./ ,....,,, ~,,,.,~/ ~,'/t.,..Ft..,,,./ _~.'1~';. ~....,. ,,.,~,~ WAS GROUND ENCOUNTEREt M0nil0dng? -~%..........q~ ~, ~' , .." ~.~.~ · . ! 2 3 4 5 6 7 8 9 ~0 - UNO WATER ~2- 13- SLOPE II II SITE PLAN 14 - Reading Dale Cross Nel Depth to Net ..~-~ ~ Time Time Water Drop 7 " ~ ~.'~ ~o.,. ~ ~" ~., ~6- ~ ,, /~.,~ 7~...' ~ ~.. ~ ,~.. 18- 19- 20- 1~ [' P~ Iminule~i~h) PERC HOLE DIA~ETE~ ~ ~ TEST RUN BETWEEN . ~ FTAND ~ FT COMMENTS BY; ,~''''''~'''~'/'. I'"~-~~~"~ CERIlFY THA1 1HIS 1EST WAS PERFORMED IN PERFORMED ACCORDANCE WITH ALL STA~E AND MUNICIPAL CUIDELINES IN EFFECT ON 1HIS DAI E. EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 Dalzell-Schneiter Lot 18, Blk 2 / 94-019 SHEET NO OF CALCULA,ED s¥ L.B. DATE 05/14/94 C.~C~ED s*. L.B. DATE 05/14/94 :.....:...._../__-_ ........ I..., ! ': , ence ~ ~ ~ ~. ~ ~ : , ~ : :, ,. . .: . : . .... ~......~4b~r~m~ =..~g~lon~r~y~) : :: · ~So~l ~ench a~hm~on m~ = .0.8 g~/ft .... :-..--.-~R~ui~ abm~tion ~m = · ~.*~ · ,0.8 = 750 ft ~ ~R~ommend~ ~ench dimension~: ......... ~.....~ .:Gmveldep~: ~.7'. . : ................................... . : ~-:~ ~ - ' MUNICI.AUTVOFANCHO.AGE DEPARTMENT 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 MAILING ADDRESS LOCATION . ~ ~ NO' OF BEDROOMS DISTANCE TO: IW~l~r /~ IAbsorp"O~e~ D~lling~,~ ~ PERMIT NO. E ~ ----__~-- DI~AN~ ~0; ~--~ NO' of lines i Length °f each~;tlin' Total leng~l?es Trench width,7~ inches k ~op of tile Jo finish grade / / Material beneath tile Total eff~ti~ absorppon area Length W~dt~ Depth PERMIT NO. ~ Ty~ of crib Crib diameter Crib depth Total eRecti~ absorption area m Well 8uildlng foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth DriUer Dastance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(si ~ DISTANCE TO: OTHER PiPE MATERIALS REMARKS ' ' ' ~APP"OVED~z~[I~ ~ >~ ~DATE LEGAL 72-013 {Rev. 3~78) PERMIT MO. MUI'-I 1' C T PFtL 1' T"~ OF "./~-' DEPARTMENT ~ HEALTH R,ND ENVIRONMENTAL/--:OTECTION~.~-~I'. ~7-/ 2~4-4720 WELL AND ON--S ITE SEWER PeR~T ~.~ INC. ~TRR ROUTE R BOX 4~4E ~50~ ~44-i~ APPLICANT SUN COHSTRUCTION, LOCATION HILLSIDE RREA TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH LOT S~E 40000 SQUARE FEET MAXIMUM NUMBER Of BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE Of THE SOIL RBSORPTIOH SYSTEM IS: DEPTH= :I_O LENGTH= ----~-4 GRFIYEL DEPTH= ~: THE LENGTH DIMENSION IS THE LENGTH <IN FEET~ OF T~E TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GR0U,~D AND THE BOTTOM OF THE EXCAVATION ¢IN FEET>. ~ THERE IS N0 SET WIDTH FOP, TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH Of GP,AYEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM Of THE EXCAVBTZON (IN FEET>. REQU lr RED SEPT I C TRt~I~.. S I ZE= 12-=;O GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF RHY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO (2~' II'-iSPECTIONS ARE REQUIRED BACKFILLING Of RNY SYSTEM WITHOUT FINAL INSPECTION RND APPROVAL BY THIS DEPRRTHENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEH R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS IQ0 FEET FOR R PRIVATE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PP, IVRTE HELL TO R PRIVATE SEWEP` LINE IS 25 FEET AND TO R COMMUNITY SEHER LINE IS 75 FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE ~,'ELL COMPLETIOH. OTHER REOUIREMEHTS MAY RPPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGP`AMS RP,E RVRILABLE TO INSUP,E PROPER INSTRLLRTION. PERM I T e~:P I RES DECEMBER I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS AHD WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: i UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. V4. 0 ~IUr~ICIPRLIT~r' OF RNCHORR8E DEPARTME~T,~"'~ HERLTH BND ENVIRONMENTRL ~OTECTION 82~' ~ STREET, ANCHORAGE, AK. ~5 ~l . . 264-472e LdELL Rt4D Ot4--_~ I TE SEi4ER PERM I T LOCRT%ON ........................... /. .................. . LEGRL ;~-~" ~ ~ .... ~:~t.f/-~c~(7~...~'LOT SIZE~;~°~ SQUARE FEET TYPE OF SOIL RBSORBTION 5~STEN IS: ~r~ ~RXIMUN HUMBER OF BEDROOM~ = ~ SOIL RATING (5Q FT/BR)= /00 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTE~ IS; DEPTH= ~ 0 LEt~GTH= ~ GRRVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOI1 OF THE EXCAVRTION (IN FEET). THERE IS HO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH ~ THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQUIRED SEPTIC TANK SIZE= }~ GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TI,~O ( 2 ) I r~ISPECT I Or.IS ARE RE(;]U I RED BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL AND RNV ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL; OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. PERM I T E:'{P I RE--'5 DECEMBER :3:'t.. '1 ~"3 80 I CERTIFY THRT l: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLIT¥ OF RNCHORRQE. 2: I WILL INSTRLL THE SYSTEM IN BCCORDRNCE WITH THE CODES. 3: I UNDER~TRND THRT THE ON-~ITE ~EWER SVSTEH HRV REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. December 29, 1978 ~780928 J. Bumgardner Star P~ute A Box 474-E Anchorage, Alaska 99507 SubJeet~ Lot 18 Block 2 Dalzell-Schneiter Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar y6ar basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist ~m/ljw enc: copy of permit PERMIT NO. .... ~M..U....N~ I.C ! p~L I TY O~'--f~-~ E' EP~TMENT O! .ZRLTH 'RND' ENVIRON,ENTRL 825 'L' STREET, RNCHORRG~ ~4-4~ WELL 8~D ON--SITE SEWER PER~IIT ( 788928 ) 'RPPLICRNT J. BUI~R (DB8 SUN C BOX 474 E SRA ~LOCRTION ILEGRL I-t8 B2 DRI. ZELL-SCHNEITER TYPE OF SOIL RBSORBTION SYSTEM IS: iMRXIMUM NUMBER OF BEDROOMS = 4 iTHE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM LOT SIZE 244 i~ 49294 SQURRE FEET TRENCH SOIL RATING (SQ FT/BR)= DEPTH= :1.0 LENGTH= 2~4 GRRVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DIST~4CE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). REQUIRED SEPTIC TRf4K SIZE= ~1.250 GRLLOr~$ :PERMIT RPPLICRNT HR~ THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF 8NY WELLS RDJRCENT TO THIS PROPERTY RND THE --~ NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. .*=.. TWO (2 ;) INSPECT IONS FIRE REQU I RED BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND APPROVRL BY THIS :DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINII~ DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS il~8 FEET FOR R PRIVRTE WELL~ OR ,,, ii58 TO 2B8 FEET FROM R PUBLIC ~LL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ~E ~I~D R~ ~T BE RET~NED TO THE ~P~T~ WITHIN 30 DAYS ~OF ~ ~LL C~ETI~ OTHER ~IRE~$ ~ R~LY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRIL~LE TO I~ PROPER INSTALLRTI~. " PERMIT E}<PIRES DECEMBER ii CERTIFY THRT I: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET iFORTH BY THE MUNICIPRLITY OF ANCHORAGE :2: I WILL INSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. V3. 2 PROJECT ' CLIENT W.O. SOILS TEST HOLE NO. ELEV. TOP OF HOLE DATE. 11/3/76 SHEET '12 2-19 443 4: OF 14 12" Forest Duff 18" Damp~ Yellow-Brown, Orqanic Silt (OL) Damp, Yellow-Brown, Silty Sandy Gravel 2-19 Cobbles DAmp, Brown Sandy.~ravelly Silt (GM) Damp, Brown, Silty S~nd (SM/SP) Damp, Brown, Sandy Gravelly Silt (GM)' Bottom, Dry Hole t [ ~1 .........,,T,-,L ,c ,0,~.,..,~ .ti DEC 8 1§7~ RECEIVED COSA Checklist_May2025.docx COSA Checklist Legal Description: DALZELL-SCHNEITER BLOCK 2 LOT 18 Parcel ID: 015-291-30 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 JULY 1980 Total depth 59 ft Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 43 in. Date of flow test for COSA 7/8/25 Static water level at beginning of test 20 ft. Well production at time of test 4+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 5.04 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 7/9/2025 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 7/2/1980 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert* from grade 3.6 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective 5.6’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/11/25 Results Pass Fluid depth prior to test 25 in Water added 900 gal New fluid depth 53 in Elapsed time 1440 min Final fluid depth 25 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in (MOA 6’ ED) Effective depth used 30 in (Missing ED + Final Fluid Depth) Effective depth remaining 42 in Comments/Deficiencies: Tested the in-use trench (1980). The 1994 trench was dry. Approximate total measured depths from existing grade. ED per elevation measured shots *(Diverter invert), visual observations, MOA records & appears approximate. COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *8’+ ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: 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 *WAIVER REQUESTED & ISSUED WITH THIS COSA SUBMITTAL. 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 09/03/2025 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 & 09/03/25 Municipality ® ()e �a 'fmrnT P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Develol2ment ServicesDivision On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV251038 PID#: 015-291-30 COSA* OSC25139 Permit#: Legal Description: DALZELL-SCHNEITER BILK 2 LT 18 Engineer: First Water Consulting Your request for a waiver of the required 10 feet horizontal separation from the disposal field to the property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing disposal field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Z 7 Approved by: ame of Reviewer ............................................................................... **** VARIAN C E/WAIVER REVIEW **** 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 28, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: DALZELL-SCHNEITER BLOCK 2, LOT 18 – FIELD TO LOT LINE WAIVER Per MOA records and the current as-built survey, it appears the existing field is approximately 9’ from property line and therefore respectfully request a field to lot line waiver of 8’ be granted at this time. Letters of Nonobjection (LNO) along with a MOA Right of Way (ROW) permit has also been obtained for this slight encroachment. Granting of this waiver is justified since the existing field has been in operation since 1994 with no known issues or ill effects to the subject or adjacent property, adjacent property absorption systems are nonexistent and 20’+ from the end of this leach field and it is anticipated that the field will not impact the neighboring property. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 015-29-130 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~ ~Ach'L~ 1"~ ~0~ ~ 1. GENERAL INFORMATION Complete legal description Dalzell Schneiter Lot 18, Blk 2 Location (site address or directions) 10151 Evergreen, Anchorage Property owner Greqory Dos & Marianne See Day phone 345-6526 Mailing address 4200 Southpark Bluff D=ive, Anchorage, AK 99516 Lending agency(]v~'C/Henri P~3os Day phone 562-2181 Mailing address 701E. ~udor Rd.. Suite I07, Anchoraqe, AK 99503 Agent N/~ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: X Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Se STATEMENT OF INSPECTION BY ~ENGINEER As certified by my seal affixed hereto and aSof the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the dat.e of this inspection. Phone 694 -5 ] 95 9957 Name of Firm Eaqle River Enqineerinq Services Address P.O. Mw 77~q4: v~l~ ~t~. h]~ Engineer's signature ~ bedrooms. DHHS SIGNATURE / Approved for Disapproved. __ Conditional approval for bedrooms, with the following stipulations:' By: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work· Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth I~,~LZE/-L: ~C~,,V~/77~,E. Parcel I.D. &¢'[ /~' ,'5~-/" Z If A, B, or C, attach ADEC letter. ADEC water system number ¥d$ Date completed ¢'7/~'D Driller 5<] ~ Cased to ~, 9 / Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level ,~5// Well llow /.'~ Pump level1 Wires properly protected (Y/N) AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holdieg tank on lot /¢'~'/~ ' Absorption lield on lot /z/g/ Public sewer main /~//~ Sewer service line g.p.m. · /',,13 · ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate ~-- 1~/~- Other bacteria Collected by: B. SEPTIC~,|CLOING TANK DATA Date Installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / ~. ,~. Q Compartments Foundation cleanout (Y/N) ~C .~ Depression (Y/N) Alarm tested (Y/N) ,A//~ -' /%//E/,'~ Pumper. / SEPARATION DISTANCES FROM SEPTIC/t:IOL,DtNG TANK TO: Well(s) on lot /~-/'¢ ~ ¢ On adjacent lots To property line ~,~7 ~" Absorption field Surface water/drainage Foundation ~ j Water main/service line Z./~ ' ~.o~ (~)' F~ CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent (Y/N) , 'Pump on' level at High water alarm level ~ ~..~ J Meets MOA electrical cod..~~ SEPARAT~...~STANCE FROM LIFT STATION TO: Well o.~Hof- On adjacent lots Manufacturer ~. ~ Manhole/~Acc ~) ~ 'Pump off" Level at Cycles tested Surface water. D. ABSORPTION FIELD DATA ~IVE~-EIo/JJ/E~U~ Oateinstalled ~b/~./?~/ I ~'7/$DSoilrating(GPDIFF) ~.~ &?42 / ~ Systemtype · /v~,. Total absoq:~ion area ~4 ~ Date ~ adequacy lest /'///~ . Water level In absorpllon field before test I · . -~ / ~ ..T,O ~' Gravelthidmess Cleanout present (Y/N) Results (pas.~la~) Peroxide treatment (past 12 months) (y/N) b//~ Depression over field IY/N) for ~/7" Bedrooms ~er test yes, gWe date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~'(~ ' On adjacent lots ?~/D~ ~ Property line To building foundation ..~ ~ .To existing or abandoned system on lot On adjacent lots ~ ,~ 0 ~ Cutbank /"///~ Water mai~service line Sudace water /,//~ Driveway, parldng/vehicle storage area " Curtain drain ~ /~//~ " E. ENGINEER'S CERTIFICATION I certi[y ~at I have checked, verified, or confon'ned to all MOA and HAA guidelines in effect or~ the date of this inspection. Signature Engineer's Name Date HAA Fee $ Date of Payment Receip~ Number 72-026 (3/93)* BacX CATE RECEIVED -~ INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE IO'.3o ~,.~..~¥ ~.o-~3-~ INSPECTOR INSPECTOR INSPECTOR~, uN,aPAu oF MUNICIPALITY OF ANCHORAGE D~PT. OF HEALTH & ENVIRONMENTAL SANITATION DIVISION SEP Telephone ~7~ DECE/t/E~ MAILING ADDRESS TREET LOCATION TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One I--1 Four [~SINGLE FAMILY [] Two r'] Five [] MULTIPLE FAMILY [Z~hree [] Six [] Other 7. WATER SUPPLY ~,-'"~NDIVIDUAL* * 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.) S. SEWAGE DISPOSAl. SYSTEM {~.'~NDiViDUAL/ON.SITE'O t/'¥ (¥"U 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 I-'1 ONE D THREE [--I FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX 2. WATER SUPPLY PERMIT NUMBER I'--1 INDIVIDUA~L ' DEPTH OF WELL I--'1 . COMMUNITY ' DATE DRILLED I-'1 PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I-'lIN DIVIDUAL/0N -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER I--ISepticTanl< or I-'lHoldingTank /A.~. ~--_~. , Size: !-~-~"~ If Tank is homemade ' SOILS RATING give dimensions: 1 (~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72.010 (Rev. 6/79)