HomeMy WebLinkAboutTHE VILLAGES TIDE VIEW LT 16
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241021
Work Type: Septic Upgrade
Tax Code Number: 02009161000
Site Legal Address: THE VILLAGES TIDE VIEW LT 16 G:3336
Site Mailing Address: 16815 TIDEVIEW DR, Anchorage
Owner: MCCONNELL ROBERT J JR & TERRY
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
nlcnt
�o Ste.
l�epartmeut
3/26/2024
3/26/2025
55825
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 surface water to the north is to be confirmed and located. A berm may need to be constructed to
ensure daylighting effluent will travel at least 50'.
2. Prior to construction, the water line is to be located to ensure that the required separations will be met.
3. Show the water line on the record drawing.
4. Prior to construction, the well on T11 N R3W SEC 3 LT 3 S2 AND LT 4 PTN is to be located.
J
Issued By:
j
Date:
Date: 31a6 /7-
3/26/2024
z
4
j' Municipality of Anchorage
— 1)r.partment
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
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV241021 COSA#: Permit#:OSP241021
PID#: 020-091-61
Legal Description: THE VILLAGES TIDE VIEW LT 16
Engineer: Garness Engineerinq Group
Your request for a waiver of the required 50 feet horizontal separation from the absorption field to
the excessive slope has been approved. The approved separation distance is 20.0 feet.
This waiver approval applies to the proposed absorption 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.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: X,7612 - Approved by:
Name of Review
U 0 0 0 R M K 0 07 M U 0 M M N 0 M M U M 2 0 2 0 M N ,
**** VARIANCE/WAIVER REVIEW ****
MUNMPAUT ` OF ANCHORAGE
Development Services Department \ }r:; a' Phone: 907-343-7904
On -Site Water 8, Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 020-091-61
Property owner(s) ROBERT MCCONNEL Day phone 907-529-2275
Mailing address 16815 TIDEVIEW DRIVE *ANCHORAGE, AK
Site address 16815 TIDEVIEW DRIVE *ANCHORAGE, AK
Legal description (Sub'd., Block & Lot) THE VILLAGES TIDE VIEW; LOT 16
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field 0 Initial ❑
Single Family (SF) Q
(w/wo ADU)
Septic Tank 0 Upgrade Fx I
El
(D)
Holding Tank ❑ RenewalDuplex
❑
Multiple Dwellings ❑
Privy ❑
(SF 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 authorized agent)
Permit/Rush Fees: Waiver Fees: / �f
Date of Payment: 2 b Date of Payment:
Receipt Number: Receipt Number:
Permit No. V 5 7 2 Waiver No. Q% V 2 q I C,)1 U
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsWermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241021, Deb Wockenfuss, 03/26/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241021, Deb Wockenfuss, 03/26/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241021, Deb Wockenfuss, 03/26/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241021, Deb Wockenfuss, 03/26/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241021, Deb Wockenfuss, 03/26/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241021, Deb Wockenfuss, 03/26/24
AGGREGATE/SOILS TEST REPORT
PROJECT:DATE TAKEN:
PROJECT NO.:DATE TESTED:
CLIENT:TESTED BY:
SAMPLE NO.:REVIEWED BY:
LOCATION:DESCRIPTION:
SIEVE ANALYSIS TEST GRAIN SIZE DISTRIBUTION
(ASTM D422)
Sieve Diameter Total %% Gravel:57.2
Size (mm)Passing %Sand:35.3
6"152.4 % Fines:7.5
4"100.0 D60:10.98
3"76.2 D30:1.87
2"50.8 100 D10:0.17
1"25.4 81 Cu:64.1
3/4"19.0 74 Cc:1.9
1/2"12.7 63 % .02 mm:
3/8"9.5 57 % Moisture:7.2
#4 4.75 43 Fine Modulus:
#10 2.00 31
#20 0.85 22 (ASTM D4318)
#40 0.425 16 Liquid Limit:
#60 0.25 12 Plastic Limit:
#100 0.15 9 Plastic Index:
#200 0.075 7.5
(ASTM C127)
HYDROMETER TEST Bulk SpG:MOISTURE-DENSITY RELATIONSHIP
(ASTM D422)SSD SpG:
Elapsed Diameter Total %Apparent SpG:
Time (min)(mm)Passing % Absorption:
0
0.5 (ASTM C128)
1 Bulk SpG:
2 SSD SpG:
5 Apparent SpG:
8 % Absorption:
15
30 (ASTM D1557)
60 Dry Den (U):
250 Dry Den (C):
1459 M% (U):
2750 M% (C):
SpG (assumed):
M-D Test Method:
CLASSIFICATION:Well Graded Gravel w/Silt & Sand
USC:GW-GM
FROST CLASS:
Remarks:
12/27/2022
IN SITU
22-415
EKLUTNA ENGINEERING
22P1373
TEST SVCS 2022
JOHN A. BUZDOR, P.E.
10/18/2022
10/20/2022
NFP
JAB
16815 TIDEVIEW DR
110
115
120
125
130
135
140
145
150
0 2 4 6 8 10 12 14DRY DENSITY (PCF)MOISTURE CONTENT (%)
0
10
20
30
40
50
60
70
80
90
100
0.0010.010.1110100% FINER BY WEIGHTGRAIN SIZE (mm)
3335 Arctic Blvd, Suite 100
Anchorage, AK 99503
Phone: (907) 564-2120 Subject to review by our Materials Engineer REV 1-29-20
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MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this 20 Day of #141�Cfl of 20t�- , by and between
f� C `.� �2 �2 ,herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Adv Rced Wastewater Treatment System (AWWTS),
described as JU.aA e- S
located at (legal description)
vc 1%1 E t0 `U
Auche"&
2. Maintenance, Repairs and Alterations.
l h� U►'I���
(Owner is required to read, understand and initial each section)
AThroughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
placement costs, and inspection costs. This
repair(s), maintenance, adjustment(s), re
includes a4nnual maintenance"fe((typically $400 to $600"'
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
i
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
e)
Date: 3 ZJ�;,—�L,5
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this
,00 day of ,
20Z4�, b --R ► Q-iC 0
I�IIGIIT�////
\\\\0PN
TAR LIC FOR ALASKA
My Commission expires: '
NOT
*; Al j ARY
/5/1'11 O�ALNS P'\PMUNICIPALITY:111111/
By:4� (signature)
Date: 3 /Z c -/-z �{
(print name)
Title:
(rev. 05/18/2018) Page 3 of 3
MUNICIPALITY OF ANCHORAGE
A ? DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM ANIS/OR WELL INSPECTION REPORT
�
� �
NAME
PHONE
NEW
❑UPGRADE
MAILINGADDRESS
LEGAL DESCRIPTION
16'
LOCATION /
NO. OFPDROOMS
U
DISTANCE TO:
Well
�L%�j
Absorption area
�Q�
Dwelling r
/a
PERMIT NO.
eo U
_Y
a Q
W I.-
Manufacturer
Materia
No. of compartments
N
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
0 ❑ z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
0z<
Manufacturer
Material
Liquid capacity in gallons
❑
w =
DISTANCE TO:
Well /
(JO
Foundation
3U (
Nearest lot line
e
/0
PERMIT NO
J LL Z
F- Z W
No. of lines
Length of each line
S
Total length of lines f
Trench width
inches
Distance between lines
FTop
p
of tile to finish grade I
Material beneath tile
inches
Total.effective absorption area
(fL7
W
C7
Length
Width
Depth
PERMIT NO.
Q F-
wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
U.]
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Clash
Depth
Driller
Distance to lot line
PERMIT NO.
W
�
DISTANCE TO:
Building foundation
Sewer line
r
Septic tank lC� Ut
Absorption area(s)
'
OTHER
PIPE MATERIALS
r
SOIL TEST RATINGAle T- e_v l✓ -vi 3' T AI7 -
/,)o
INSTALLER
I;
REMARKS
SS �wlO��i,
Z 77
APPROVED DATE /] LEGAL
'11013't9ev. 3/78) i--)
��k����� ���-���� TO FO �PA��w���� |��o
' .DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION y2'
825 'L' STREET, ANCHORAGE, HK. 99501
264-4720
&A
&A 104_`> I _T_ E7 As EE &-A Eo Q F' ���IF
�
PERMIT NO ( 800119
L ��_
APPLICANT ROBERT D. CHRkSONPI P. O. BOX 10-905 UNI. -f.
LOCATION RABBIT CREEK
LEGAL LOT 16 BLK 1 VILLAGES TIDE VI. LOT SIZE 5500 SQUARE FEET
/
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 170
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
120071=47-41= AK73 �� u:EiFQfA%?E=L_ E>E=F"1Fhq= 10
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
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.
___ _F &--Q -:_9 < > 1 54 05 F" Eo CD IF 1 OD F:� F? E= ����I �= C_-
BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
V0000001 1 7- �11150" I Tw?Eowtow 1200121071-REENEEF2 71AL^ AL <9 E3 Cc- 0
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:_ __o
APPLICAN_ ROBERT D. CARLSONN
ISSUED BY TE�1 _ Y4.0
❑ SOILS LOG
MUNICIPALITY 0' ANCHORAGE
DEPARTMENT OF HEALTH AND !:NViRONMENTAL PROTECTION TEST
OLATION
1=' Pouch 6.650, Anchorage, Alaska 99502 276-2221
\ t
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: I ��, c//!' /CTS t DATE PERFORMED: C C1'1��`
V _
LEGAL DESCRIPTION: �U �� T /r' �'�s ��a S t'S 1 C� e u r w)
DEPTH SLOPE SITE PLAN
(FEET)
I 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
r—
WAS GROUND WATER S
--
ENCOUNTERED? )IU L
O
IF YES, AT WHAT E
DEPTH? '
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
qj
%.0
'7 5
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN �'` FT AND 5 FT
PERFORMED BY: �Gr i( �cL ��t'-� CERTIFIED BY: :� ) \% (!�� DATE:
iJ
72-008 (7/76)
10-J4 LK
d O 1 jAr i Kw worn, corunoi
-17
LAND AND W4 TER M4NAGEMEAT)X1_X>iX ATX )4)"X E>C4dr #" XMVX
SOUTHCENTRAL DISTRICT 3327 Fairbanks St.
Anchorage, AK. 99503
August 9, 1978
RE: Water Rights Application
File Number, ADL: 200713
Pete & William C. Payton
320 E. 12th
Anchorage, Ak. 99501
Dear Gentlemen:
y Your application for water rights has been received in this office •�
accompanied by filing fee in the amount of $10.00.
Applications for water rights are being worked on an area basis
relative to population density. Adjudication is proceeding as ra-
pidly as the State's staffing capabilities will allow and we may
be contacting you as we work your area.
All applications are serialized and made a matter of record on
land status plats of the State Division of Lands as they are
received. When corresponding with our office regarding your appli-
cation, please refer to the ADL number shown above. Our date of
receipt of application establishes the priority date for any water
right issued.
Any advertising charges required must be paid by the applicant.
Sincerely,
THEODORE G. SMITH, Director
Divisi
on of Land and Water Management
fo"�
By: (Ms.) DEE KOESTER
Water Assistant
Southcentral District
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O O O O O O O O O O O O
E MUhIICIPgLITY
PF ANCHU'' P.AGC
DEPT. G is ^;T I £ �'
Ei!'�I!;O�!,�?LNT•,a� r�o�CrloN; ,� W
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RECEIVED
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description /-,CT /~, ~ I./0 ([~.~,~ "~,'d/~'~ ~
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent .'~'~ o
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
Day phone
Day phone
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 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 furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supp(y and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
DHHS SIGNATURE
,.~ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedroom.~ with the following stipulations:
P-.y:
Additional Comments
The Municipa=ity of Anchorage Department of Health and Human Services (DHHS) issues Health Authorit'/
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
proYesslonal enginee r registe red in the State of Alaska. The DHH$ does this as a co urtssy to purchasem of homes
and their lending institutions in order to satisfy ce rtaln federal and state requirements. Employees of D HHS do not
conduct inspections or analyze data before a certificate is Issued, The Municipality of Anchorage is not
responsible for em3rs or omissions in the p~'ofessional engineer's work.
Municipality Df Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Lcgal Description:
A. ~ DATA
Well type 'l~
Log prcscal (Y/N)
ToN ~
Samla~. scaJ (Y/N)
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEC water system number
y Date completed -7'Z,,~-/~ ~
~ L~ c~ ~o ~/~.k Casins Im~ht (abo~c grou~l)
Date of lest
Static water level
Well pmduc~on
WATER SAMPLE RESETS:
Coliform ~
Co. d by.: --%
SEPklC/HOLD[NG TANK DATA
AB~ORWrlON I"!~':!,D DATA
Fhdd ~ ~ I (i~.) ~ Sam: = &~ ~.p.d.
~m~ ~t (~ 12 mon~) (Y~) ~ [ ~ If y~. give
LIFT STATION
Dale il~sl~dled
Si,,~ in gallons
Manhole/Access (Y/N)
"Pump on" level al*
· 'Pump off" level al*
High water alarm level at*
Cycles tested
*Datum
E. SEPARATION DISTANCES
SEPARATI~}N'DISTANCES FROM WELL, ON LOT TO:
Absorption field on Im
Public sewer nmin
Sewer/septic service line
: On adjacem Io~s
: On adjacent lots
Public ~r m~nhoi~cl~i
Cia ~on
SIqPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation I '3~ I Property line > .gg2/ Absoq~on field
Watgrmain/serviceline ,~ I0 S~wnter/di'aJnage IMIO Wefl$onadjacemlots
Building fouprb6on
Surface water
Cut'lain drain
SEPARATION DISTANCE FROM ABSORPTION FI~LD ON LOT TO:
· 7~ 't.
Water mni~/se~vice lip~ ~ t Z~ '-
Driveway. parking/vehicle storage area
Wells on adjacent lois ~ /~'{) Pmk.' line
r. ENGINEER'S CERTIFICATION· ~ ~.., ..._~?- - .'.;-:: ~,..
I certif, v that I hm,e determined thr~J~eld insl~ections and rm,iew ofMunicip<tl re~,d~, ~t~.ub~ve.~.~ltltts
in conjbrmance with MOA HzL4 ~uidelines in effect on this date.
Rex,. 8195 OSS: haa.wk.doc
Waiver F~ $
Dam of Payment
Receipt Number
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
.Parcel I.D. '
/~/~- ~c/~
A. WELL DATA . ·
Well type ?/'~ ~/~ I/~- If A, B, or C, attach ADEC letter. ADEC water syste~ number
Log present (Y/N)
Total depth '~ / "~
Sanitary seal (Y/N)
Date completed "7"'/~ ''~ ¢3C~ Driller '?
Casedto ~~I~'~' Casing height
Wires I~roperly protected (Y/N)
· Date o~'iest'
Static water level
Well flow
Pump level
FROM WELL LOG
?.-1~.'72 -
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main /~I/A
Sewer service line ~.,///~
WATER SAMPLE RESULTS:
Coliform ~
Da,e of samp,e: J?' ~J)'
Nitrate
; On adjacent
; On adjacent lots
Pub,c sewer manho,e/c,eanout
Petroieum t~nk
~. ~ Other bacteria
Collected by: ,.~¢ ~/C"/~ r' ~/1/0 ~/.
B. SEPTIC/HOLDING TANK DATA
Date Installed ' I~''; V --'~'~ Tank size ] ~ ~ ....
Cleanouts (Y/N) ' :Y' "' ' 'Foundation cleanout (Y/N)
High water alarm Alarm tested (Y/N) /~//Z/-.,
Date of pumpin{j.,. ......'..-tO 'Z-~' (~'[ Pumper
SEPARATI~N~ DISTANCES FROM'SEPTIC/HOLDING TANK TO:
.. "2 ,'~ ... 7_.~
Well(s) onlof' ' ,. . . ..,, "' iOn adjacent lots
'-~'b~;G~,'.'"';', ~' , 9"7'
~ To property line ~"~,,'.~_'~x/' Absorption field
SUrface water/drainage b2 !
Compartments
Depression (Y/N)
Foundation
~atGr maln/se~icG line
72-026 (Rev. 7/91} Front CONTINUED ON BACK PAGE
C. LIFT STATION r. j, , , , . ,. ~, ~
Date installed I'J[~[' -, '' ~: ' *' ,'.~M~.~'
Vent (YIN) "Pump ~ ~p dF I~1 at
High water alarm level / Cy~d
Meets MOA~~ ~ ~ ~ ~ ~-
W n lot " On adjacent lots ~ Sudace water
D. ABSORPTION FIELD DATA
h
0
rote installed ' :'* '
Length
' '
Iota absorption area
F~ -,~ \ ii ~ ~ , ~ ; Al/
Depress~oa over field (Y/N)
Soil rating ~' ~ O '
Gravel thicl~n~-s~ "~ ~
Cleanouts present (Y/N}-
~ ::: Date (~f adequacy test'
On adjacent lc;ts
Surface water
Curtaindrain-
Results(pass/fail) for
Peroxide treatment (past 12 months)(Y/N) G;~ Y'/~)I'-~ If Yes. give'date
SEPARATION DISTANCE FROM A'BSORP~IoN FILLD TO:
Wellonlot f~'~ -' ' On adjacent lo,$ /']~'~' Propertyline 2~,'
TO building foundation ' ~"~ ' To existing or abandoned system on lot"
' System type ~'
Total depth
bedrooms
E. ENGINEER'S CERTIFICATION
Cutbank ff"~'~ Water main/service line
Driveway. parking/vehicle storage area
HAAFee$- '/~
Date of Payment
Receipt Number
I cerlify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the'date of this inspection.
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Re~. ~1) ~lCk MOA 21
5. 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 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 date of this inspection.
Engineer's signature _ Date
-'-"' ....:'' -=--' ....--' ...... ' ' ;' · ' ~ ' ....... "':'": -~.-'-~o~.a ~:. K,,J.~.t;;': ,~. -. ....... -.- ·
DHHS SIGNATURE '
)~, Approved for ru ~ ~ (l~L~
Disapproved,
Conditional approval for
Se
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
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 ir~dependent
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
responmble for errors or~m~ss OhS n the professional engineer's work.
~'"~JNICIPALITY OF ANCHORAGff~"~
DEPARTMEI, I-~F HEALTH AND ENVIRONMENI~-PROTECTION
825 L Street, Anchorage. Alaska 99501
264-4720
Date Received: April 12, 1978
%1: Time 9:30 a.m. ~2: Time #3: Time
Date 4-19-7~ Wed Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER~ACILITIES
1. Lending Institution Request:
Mailing Address: ~V~ Phone: o
2. Property Owner: William C. Payton Phone: 276-3355/w
Mailing Address: 329 East 12th Avenue
279-3359/h
3. Legal Description: Lot ~Block 1 The Villages Tide View Subdivision
4: Single Family Residence: ( ) Number of Bedrooms:
Multiple Family Residence: (x$ Number of Bedrooms:
Nine
Se
Well System:
Permit #
Construction
Individual well (x) Community/Public System ( )
Depth of Well Well Log on File
Bacterial Analysis
( )
®
Sewage
Permit #
Septic Tank Size
Absorption Area
Disposal System: On-site System (x~ Public Utility (
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
~ I · MUNICIPALITY OF ANCHORAGE. -
~Q~ J Department of IIealth and Environmental Protection
' (f~'~/ 82?
~equest for Approval of Individual Sewer and Water. Faczl~tie~
Mailing Address:
2~
Name of Buyer:. ~.. _/
Mailing Address: ~--c---------~'Phone:
®
Lending Institution:
Mailing Address:
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Phone:
Phone:
Single Family Residence:
Multiple Family Residence:
( ) Number of Bedrooms:
(~ Number of Bedrooms:
7. Water Supply:_ *Individual Well
Public/Community
System
(
)
If Individual Well, well depth 'I~ ~;~
If Community System, name of system
Sewage Disposal System: *~n-site System ~ Public System ( )
8.
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
Page Two
· ' Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 15 Block 1 The Villages Tide View Subdivision
Comments:
Affadavit Attached:
Letter Attached: ( )
Approved: Date:
Disapproved: Date:
Department Worksheet:
July 13, 1978
Bill Payton
320 E. 12th Avenue
Anchorage, AK 99501
Subject: L16, B 1 Tideview S/D
Dear Mr. Payton:
We have received and reviewed the plot plan of the subject
lot showing the Class C well site. The well will supply, a
triplex to be constructed on the lot. The plan is approved
for the features with which this department is concerned.
This is based on our understanding that the property owner
to the west of your lot has no objection to the well radii
restrictions which will affect his property.
cc:
DHEP
Sincerely,
James O. Starr
Environmental Engineer
GML
TI~E
DATE
INSPECTOR
DATE RECEIVED
' INSPECTION APPOINTMENTS~ ^ d~~ -'~ 2~
DATE DA'rE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~ION
B25 L Strut * A~or~, Al~a ~3
ENVIRONMENTAL SANITATION DIVISION
Tele~e ~47~
REQUEST FOR ~PROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts o~t page 1. Incomplete ~que~ts will not be pro~e~ed. Pteese allow ten (10) days for processing.
f, PROPERTY OWNER PHONE
MAILING ADDRESS
PHONE
PHONE
4. REALTOR/AGENT
MAILING ADDRESS
PHONE
5. LEGAL DESCRIPTION
STREET LOCATION
SINGLE FAMILY
MULTIPLE FAMILY
~. WATER SU~LY
INDIVIDUAL*
COMMUNITY
PUBLIC UTI LITY
S~AGE DIS~AL SYSTEM
ND VIDUA~ON-SITE**
PUBL;C UTI LtTY
NUMBER OF~BEDROOMS
[] One ~ Four
i'-1 Two I--I Five
[] Three D Six
Other ·
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log If available.)
,/~ YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Lo3
1. TYPE OF RESIDENCE
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDRO0~
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE r-I FIVE
I--] TWO [] FOUR [] SiX
[] OTHER
2o WATER SUPPLY
PERMIT NUMBER
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
F-IINDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or r-IHolding Tank
Size:
give dimensions:
TYPE OF TANK
PERMIT NUMBER
DATEINSTALLED
INSTALLER
If Tankishomemade SOILS RATING
MANUFACTURER
TOTAL ABSORPTION AR EA
MATERIAL
4. DISTANCES
WELLTO:
Absorption Area to nearest Lot Line
Lot Line
5. COMMENTS
[~'""'APPROVED FOR y BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev, 6/79)
N 89.57'32" E
N
N
S
Ate•
EXISTING
HOUSE +
0
78.9 `� `�� 23.4
?� X00, �� +
gp,
SCeN� C pR£SfR
—V
`SMT
----------------------�-•- ----
o UTILITY ESMT.
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------------------------------
O R\4SO.pp.
S Sc�- /
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0.4
NEIGHBORS
SHED
LOT 15
_000000000
49 TH �*
................................
...7enei7I:.
Dreyer•: o�.`
p4sf LS -8202
G
4440n�°fessionot �0 0
DRIVEWAY EASEMENT BOOK 426,
PAGE 509, GRANTED FOR THE
USE OF LOT 16 AND LOT 15.
>
ORDERED BY:
C::) A \,/ E W I R T I --I
EXCLUSION NOTES; It Isthe owners' responsibility to determine
the existence of any easements, covenants, or restrictions
LEGEND: SET FIND
5/8 -RB W/CAPD 5/8' RB 0
with RE/MAX
PROPERTIES
which do not appear on the recorded subdivision plat. NOTE:
Under no circumstances should any data hereon be used for
3.25• AL.MON.MONUMENT
HUB h TACK g
EEgggMg
_,
construction or for establishing property lines.
FENCE- —x— x —
SURVEY CERTIFICATION: LANTECH has conducted a
OVERHANG -
physical survey of this property as shown on this
WOOD DECKS -
t.mrite.ch
drawing and that the improvements situated there
CONCRETE -
on are within the property lines and no encroach-
ASPHALT-
ments exist other than noted.
SURVEYORS—PLANNERS—ENGINEERS
AS—BUILT O F: LEGAL DESCRIPTION:
�SEPMDPIPESS-
-
LAND doCONSTRUCTION
440 WEST BENSON BLVD. # 103
ANCHORAGE, ALASKA
99503
(907) 562-5291
LOT 16,
WORK ORDER NUMBER:
95-L-697A
DATE:
NOV 17, 1995
SCALL•
(tax) 561-6626
THE VILLAGES - TIDEVIEW-
°HA"" BY: CNCCKCD BY
NUMBE
GRiONUMBCR:
BOOK CC• A
DIAD
t
3336
REF911_336