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Home My WebLink AboutDE SPIRITO LT 2Onsite File De Spirito Lot 2 #015-082-11 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201337 PID Number: 015-082-11 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name JAMES DUCKER & BRENDA THEYERS ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6631 E 99TH Ave., Anchorage, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-346-3907 3 1.2 GPD/SF 8.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.5 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot De Spirito 2 Fill added above original grade .6 Ft. Gravel length 38 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines NSA Distance between lines N/A Ft. SEPARATION DISTANCES To • Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 380 Ft2 1 N/A Ft. Well >100' >100' N/A N/A >25' TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1,000 Gal. Surface Water >100' >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation > 1 0' > 1 0' N/A N/A LIFT STATION Manufacturer Capacity Gal. Remarks Absorption trench was installed parallel to ground contours. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer A+ Home Services Drainfield D3034 CO/MT D3034 Inspector L.Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection 151 11/12/20 11/13/20 Location and description 2nd dates: Bottom of Siding at FCO. aro 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF C ��o Conditional Approval: Date „ ��P;,.••"' ` '••:.95 &� •`' `•1 49th ........., ... .. a.n.............*, ..............uu. `. fi :, MICHAEL E. ANDERSON �� 10 W % No. CE_4381 r,' Septic System �D 1 Approved 'V� Date 11511), 1•.., 1/4/21 •°'1;J�jr � Note: this approval does not include well permit requirements.�� (Rev 05/02/18) // // // // // // // // // // // // // 535 1"=50' 38' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. 3-BDRM HOME NOTE: CONTOUR LINES WERE TAKEN FROM LIDAR AND DEVIATE SLIGHTLY FROM WHAT WAS ENCOUNTERED AT CONSTRUCTION. TRENCH WAS CONSTRUCTED PARALLEL TO CONTOURS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH PERMIT # OSP201337 PID # 015-082-11 DE SPIRITO, LOT 2 A B MH 36.4 SV 41.2 2CO 42.8 A B FD 43.9 CO1 52.2 MT1 51.2 CO2 86.2 56.2 60.6 62.3 63.1 71.7 71.85 105.5 EAST 99th AVENUE 1/6/21 FEET 0 50 100 SHED SHED DECK 10' UTILITY EASEMENT 530 525 540 1,000-GALLON SEPTIC TANK w/20" MANWAY. EXISTING ABSORPTION TRENCH CONNECTED WITH FLOW DIVERTER VALVE. FD 2CO CO1 MT1 CO2 TH SV EXISTING WELL EXISTING WELL MT2 86.9105.1 MT2 PLAN AS-BUILT 12/10/20 38' PROFILE AS-BUILT (NO SCALE) 87.75 92.65 97.2FCOMH1 SV193.75 FINISH GRADEMT1 TH#2NO GROUNDWATER 8/5/20 84.65CO1 CO275.15 84.65 93.15 ORIGINAL GRADE MT22COPERMIT # OSP201337 PID # 015-082-11 DE SPIRITO, LOT 2 DRAINFIELD ROCK 1000 GAL SEPTIC TANK 91.82 92.07 88.65 88.65 8/27/20 MUNICIPALITY F ANCHORAGE q, Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-082-11 Property owner(s) James Ducker & Brenda Theyers Mailing address 6631 E. 99th Avenue Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) De Spirito, Lot 2 Day phone 346-3907 Legal description (Township, Range & Section) Lot Size 49,514 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 1ZUpgrade ❑X ❑ (D) Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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: 14 `I q to, l �v_ I b- I )Waiver Fees: Date of Payment: Receipt Number: O D Permit No. O S Pa013 3�1 Permit App__- : .-.,:c Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 18, 2020 M.O.A. Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: De Spirito, Lot 2 – 6631 E. 99th Avenue Septic System Design Dear On-Site Services Engineer: The existing septic system on the subject lot has failed and must be replaced to serve the three- bedroom home on the property. We are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home and the existing well and the existing and proposed septic system. No conflicts exist between this proposed system and any other well or septic system on this lot or adjacent lots. The ground surface on the lot slopes to the west at grades approximating 15%. There are no slopes greater than 25% within 50 feet downslope of the proposed site. Ground contours are shown on the site plan indicating the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trenches will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water and more than 5’ from the septic tank. Please refer to the attached test hole log and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 8/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201337, Rebecca Carroll, 08/27/20 // // // // // // // // // // // // // 535 1"=50' 38' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. 3-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH DE SPIRITO, LOT 2 EAST 99th AVENUE 8/18/20 FEET 0 50 100 SHED SHED DECK 10' UTILITY EASEMENT 530 525 540 1,000-GALLON SEPTIC TANK w/20" MANWAY. DECOMMISSION EXISTING SEPTIC TANK PER U.P.C. EXISTING ABSORPTION TRENCH. CONNECT WITH FLOW DIVERTER VALVE. FDFS 2CO CO MT CO TH SV EXISTING WELL EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201337, Rebecca Carroll, 08/27/20 DE SPIRITO SUBDIVISION, LOT 2 DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 1.2 GPD/SF 5' WIDE TRENCH SYSTEM 1,000-GALLON SEPTIC TANK TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 4' 6" NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 8.5' BELOW GRADE FLOW LINE ELEVATION: 4.5' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE 450 GPD / 1.2 GPD/SF /5' WIDE * .5 (RED. FACTOR) = 37.5 LF TRENCH REQUIRED (38 LF SPECIFIED) 8/26/20 4' GEOTEXTILE FABRIC Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201337, Rebecca Carroll, 08/27/20 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) DE SPIRITO LOT 2 7/29/20 L. Tidwell DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH? - <1 6 2.5 3.5 015-082-11 JIM DUCKER 10:40 7/29/20 1 2 3 4 5 6 3 0 16 / 9 0 16 10:41 10:42 10:43 10:45 10:49 OB Professional Engineers Stamp: 8/18/20 56 sec NONE None 8/5/20 SW 53 sec 58 sec 65 sec 70 sec 70 sec 6 0 16 3 0 16 / 9 0 16 6 0 16 3 0 16 / 9 0 16 6 0 16 3 0 16 / 9 0 16 6 0 16 3 0 16 / 9 0 16 6 0 16 3 0 16 / 9 0 16 6 0 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201337, Rebecca Carroll, 08/27/20 NORTHERN GEOTECHNICAL ENGINEERING, INC. / TERRA FIRMA TESTING �j PROJECT CLIENT: Forge Engineering PROJECT NAME: DeSpirito PROJECT NO.: 5665-20 SAMPLE LOC.: Lot NUMBER/ DEPTH: 20-S-1 DESCRIPTION: Poorly -graded sand DATE RECEIVED: 8/3/2020 TESTED BY: JE REVIEWED BY: RJPC 100 90 80 70 60 50 ro 40 01 W& 30 w 20 10 0 145 140 % GRAVEL 0.0 % SAND 99.0 %SILT/CLAY 1.0 %MOIST. CONTENT 6.7 USCS USACOE FC %PASS. 0.02 mm %PASS. 0.002 mm SP N/A N/A N/A UNIFORMITY COEFFICIENT (C.) 2.0 COEFFICIENT OF GRADATION (Ce) 1.1 (ATM T-313) ASPM D1557 (uncorrected) N/A ASTM D4718 (corrected) N/A ASTM 4318 OPTIMUM MOIST. CONTENT. (corrected) N/A 3/4" PARTICLE SIZE ANALYSIS ASTM D422 / C 136 100 10 1 0.1 0.01 0.001 GRAIN SIZE (mm) GRAVEL SAND BLEs SILT or CLAY Coarse Pine C..",Meaium Ninc MOISTURE -DENSITY RELATIONSHIP ASTM D1557 20 15 — - — — 0 2 4 6 8 10 12 14 16 MOISTURE CONTENT ('/.) SIEVE ANALYSIS RESULT SIEVE SIZE I..) SIEVE SIZE (U.S) IOTAT% SPECIFICATION PASSMG (% PASSING) N/A (ASTM D2434) 152.40 G (ATM T-313) 76.20 3" 38.10 1.5" ASTM 4318 19.00 3/4" 12.70 1/2" 9.50 3/8" 4.75 #4 100 2.00 1 #10 99 0.85 #20 97 0.43 #40 64 0.25 #60 15 0.15 4100 3 0.075 #200 1.0 HYDROMETER RESULT ELAPSED DIAMETER TOTAL% TIME(MIN) (mm) PASSING 0 0.5 2 4 8 15 30 60 250 440 HYDRAULIC COND. N/A (ASTM D2434) DEGRADATION N/A (ATM T-313) PLASTICITY INDEX N/A ASTM 4318 The testing services reported herein have been performed to recognized industry standards, unless otherwise noted. No other wananty is made. Should engineering interpretation or opinion be required, NGF -TFT will provide upon written request. 11301 Olive Lane Anchorage, Alaska 99515 - Phone: 907-344-5934 - Fax: 907-344-5993 - o,u,u,.nge-tft.cmn 0 0 0 0 Z N 89 59'09' W 164 75 WRINEWMANIA OF q `�`�'�� c'9 49 1H - SHANE A. HOLT I P LS -6914 �Q4a 6 o fes Si0na� Ls�o AS -BUILT SURVEY f FF =30r NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 2, DE SPIRITO SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECI EISEMEN TO SHOW ANY VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELI NE S. EASEMENTS OF RECORD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. ARE NOT SHOWNHEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS _21 ST DAY OF NOTE: FENCELI NES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE JULY , 2020 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. THE SURVEYDATA ON THIS DRAWING IS PREPARED FOR THE OWNER OFRECORD ONLY. ANY COPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW 14712, F9 205-74 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 Anchorage, Alaska 99503 // INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION F.. c/qcr~ /)u~ SEPTIC TANK: DISTANCE FROM WELL iNSIDE LENGTH - / ~z'(u~ NUMBER OF MANUFACTURER (/---~.'~-I- MATERIAL ~:~"TQ_ ~-L. / COMPARTMENTS ~'~'*)' ' INSIDE WIDTH ' - LIQUID DEPTH LIQUID CAPACITY./'~ C~'~'C~ALLON5. ? tL-E-DRA ~N-F-I ELq3: /9/.,¢ DISTANCE FROM WELL /~.,~ I . FOUNDATION ,z~O NEAREST LOT LI~ ~ ~ oFTOTALLINEsLENGTIt___~/ NUMBER OF LINES ] DISTANCE BETWEEN LINES ,, ~//f'~ 'TRENCtt WIDTFt ~('~ IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LEITH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE.~[ DEPTH OF FILTER MATER/AL BENEATH T LE ' . IN. ABOVE TILE --~T ~ IN. WELL: ttv/~ r TYPE __ CONST R UCT ION BUILDING NEAREST NEAREST SEPTIC 'FOUNDATION__ LOT LINE SEWER LINE , ,, TANK__ CESSPOOL' . OTHER SOURCES APPROVED DISAPPROVED , REMARKS DEPTH SEEPAGE SYSTEM DISTANCE FROM: DISTANCES:. INSTALLED SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: _~ Fo~m EQ.O32 DIAGRAM OF SYSTEM GRE,.,ER ANCHORAGE AREA BOk.~JGH Department of Environmental QualiW 3330 ¢ $~ree~ Anchorage, Alaska gg503 /'l INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON ~ qq~., ~4u~ LEGALDESCR,PT,ON Lo~,~ ~o;,-;/o rib SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~'~"-'~.-'~-'~ MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF ~"/'-~---- ~ I COMPARTMENTS LIQUID CAPACITY f~) O~ALLONS. DISTANCE FROM WELL / ~)~'- ! · FOUNDATION. Z~O / NUMBER OF LINES I DISTANCE BETWEEN LINES ABSORPTION AREA ~' ~'~? DEPTH: NEAREST LOT LINE ~ 3L TOTALOF LINES LENGTH Y/t/ /~'//~'~ 'TRENCH WIDTH'~ IN. TOTAL EFFECTIVE SQ. FT. LENGTH Of EACH LINE /"~// TOP OF TILE TO FINISH GRADE ¢,.~-/' DEPTH OF FILTER ~ MATERIAL BENEATH TILE IN. ABOVE TILE ¢-/--~-~ IN. WELL: /~ 7'" TYPE __ CONSTRUCT ION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE , SEWER LINE , TANK . SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: _~'~' REMARKS: //~ ~,7 ~orm LQ-032 DATE~-~-/~;- 7~PPROV .~~'K'~ · G:A.A.B. GRE/..ER ANCHORAGE AREA BOt..JJGH DEPARTMENT OF ENVIRONMENTAL QUALITY t 3330 'C"STREET ANCHORAGE, ALASKA 99503 ~E DISPOSAL SYSTEM ~ APPLICATION AND PERMIT NAM[ OF APPLICANT INSTAL~TION OF: SEPTIC TANK ~ SEEPAGE PiT TYPE AND 'IZE OF FACILI~ TO BE SERVED ~ ~ ~ FINANCED THROUGH SO,L TEST RESULTS COMPLETION DATE ANTICIPATED DRAIN FIELD TO SE INSTALLED BY NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES;. REQUIREMENTS .-. I FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ' DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEEPAGE PIT ~¢~)/ , DRAIN FIELD .~ SEPTIC TANK I'-~ / TO NEAREST LOT LINE. ORA,N P,ELO / ~INATER MAIN TO SEPTIC TANK ~/ / ORA,N F, ELB /~ SEPTIC TANK.. . SEEPAGE PiT TO RIVER, LAKE, STREAM. SEEPAGE PIT ~/ ALSO CONSIDER AREA WELLS. SEEPAGE PIT I/~/ / DRAm CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONI""ORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIP( THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATE~%ANC/[IORAGEAREABOROUGH ORDINANCE 'No. 2B-66 AND THAT THE ABOVE DATE EQ-016(3-75) ~ r.lUN m 0 ~,,~L. T 'T'Y OF ,',NO~-t~--'~'-~' / , 825 'L' STREET, RNCHORRGE, AK. PERMIT NO '( 77i~2 > , ~_ ~.. ~ ~ ~. ~_ ' ~ ,~ // APPLICANT ARTHUR BUKOWSKI- ~ $92i WRLDRON / ~ 3 ~ ~ ~44-~4~~ LEGAL .' L2 DESPIRITO SUBD ' LOT 5IiE - 4B~4 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH ,---t'IR;.,'II'IUH HUHBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE. OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH <IN FEET)'OF THE TREHCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE. EXCRVRTION (IN FEET)... THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETHEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E×CRVRTION <IN FEET). RE'Z-~U I RED 5FPT I C ' TRr-.IK $ I ZE: :I-t3~-1'~-3 GRLLt:~I"~.I$ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R HELL AND ANY ON-SITE SEHRGE DISPOSAL SYSTEM IS · 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR R PUBLIC HELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPRRT£'IENT WITHIN .~0 DRYS OF THE WELL COMPLETION.. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER I NSTRLLRT I ON. '...'Ell I D FOR t31'-lE 'T'ERF,' FROI'I I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPALITY OF RNCHORRGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTAND THRT THE ON-SITE SEWER SYSTEM MRY RE~.UIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. SIGNED' APPLICANT ARTHUR BUKOWSKI ISSUED BY ..... _DATE___ MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section—' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-082-11-000 Expiration Date: 9/3/2025 Legal description DE SPIRITO LT 2 Site address 6631 E 99TH AVE Anchorage AK 99507 Current property owner(s) DUCKER JAMES H &THEYERS BRENDA A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: z Original Certificate Date: 10/15/2024 his Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I . D. 015-082-11 Complete legal description De Spirito, Lot 2 Location (site address) 6631 E 99th Avenue, Anchorage, AK, 99507 Current property owner(s) James Ducker & Brenda Theyers Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age 3 yrs - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ■❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 55-0 Date of Payment O / 2, Z_ COSA # 05 C 2 q 1q00 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 4.05 9/16/24 & 9/25/24 N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 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 1. GENERAL INFORMATION Complete. legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# Location (site address or directions) ~'~'~/ -~ ~"~ /~,¢ e e Propertyowner k/,11,&,,~ t'f ,~y,~/,- Dayphone.. Mailing address, c.~ ~i'~/-/o~: Lending agency. ~'f'/~rc- ' Day phone Uailingaddress /-/~o (.~. 7"c~c/_or"Rc.(7 ,4~c.~o,-~'~ ~-~: ,~5'o.~ Agent Address ..~'Oo · .Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone ~-.'~d -'~' ?~'l ~-~ ~J ~ 5'~._7 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Re~. 1/91) Front MOA a2! 5. STATEMENT OF INSPECTION BY ENGINEER Se As certified by my seal affixed hereto and as of the validation date shown below, I veri~y 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. Name of Firm Address 1'~,fi-30 Engineer's signature Phone 3' Y~--/35"5- Date ,5'-/'/5"/,~ E. DHHS SIGNATURE Approved for Disapproved. Conditional approval for ~'~)bed rc~o, ms . bedrooms, with the following stipulations: Additional Comments . ? , . .' × . --'f:~,'il['i~ The Municipality of Anchorage Department of Health 8nd Human Services (DHH$) issues Health Authority Approval Oertificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHH$ does this as a courtesy to purahasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ do not '¢onduot inspeotions or analyze data before a ¢ertificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA i~21 CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 M.O.A., DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: May 14,1992 14530 ECHO ST. ANCHORAGE, ALASKA 9951.6' RECEIVED. MAY 1 5 1992' D Municipahty of Anchorage ept. Health & Human Services Per the request of Violet Hulce at ReMax Properties we have inspected the repairs made iff response to the conditions placed on the Health Authority Approval (HAA) certificate recently issued for Lot 2, Despidto S/D, located at 6631 East 99th Avenue. " (1) A concrete slab has been poured around the well head. The construction of this slab is such that' surface water originating as rain or snowmelt in the vicinity of the well would not collect there, but inste,sd .would tend to flow in a northerly direction away from the well (2) The septic tank cleanout pipe has been repaired such that it now allows unobstructed access into the septic tank. On the basis of this inspection, we believe that the conditions placed on the HAA certificate have now been satisfactorily taken care of. Sincerely, Ted Moore, P.E. cc: Violet Hulce, ReMax Properties (w. Invoice) Carol Nesbitt, GMAC " MUNICIPALITY OF ANCHORAGE DEPARTMENT OFHEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section' P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D.# ["~\-~ - t'",~- ~,'\ 1, GENERAL INFORMATION -'Complete legal description 'CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR ASINGLE FAMILY DWELLING HAA# ~ ~"~ ~/~ ~l~ ~) Location (site address or directions) Property owner Mailing address Lending agency Mailing address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: e V./,Ih~, ~y~' Day phone ~-/w,~ c Day phone Day phone. TYPE OF WATER SUPPLY: Individual well. community well ¢//o ~- 7~- [7[/ NOTE: Public water If community well. system, provide written confirmation from State ADEC attest- ing to the legality and status of system. , TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site HOlding tank" Commu'nity on,site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA J21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the valid~ti0n 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. 'Engineeffssignature '~~ ~ ~ '~ 'Date DHHS SIGNATURE Approved for bedrooms. · Disapproved. ·, Conditional approval fOr bedrooms', with the following stipulations: Additional Comments By: , Date ._ _ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in p~i'agraph 5 abo~,e 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 respohsible for errors or omissions in the professional engineer's work. ?2-025 (Rev. l,~1) B~ck MOA~21 Municipality,of Anchorage . Departmerit of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /_o~ ~-~ ~.c/~,c,'/o ~'/D Parcel l.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Io'7' Sanitary seal (Y/N) N Date completed Cased to FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I t~;' ~ C- o. Absorption field on lot t~o* ~ c.o. ~' t~'7'7 Driller Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION ; On adjacent lots ;=, too · ; On adjacent lots ;> to~, Public sewer main Public sewer manhole/cleanout ;~ ~oo, Sewer service line ~, 5-0' Petroleum tank Noe~ $¢~', WATER SAMPLE RESULTS: · .. Coliform Date of sample: Nitrate o. Collected by: Other bacteria Bo SEPTIC/HOLDING TANK DATA Date installed .5'/14' I '7'7,:';:~,.. . Tank size Ic, oo ~'~! Compartments Cleanouts (Y/N) Y'~ ;('i');',~',r;' F(~'~r{'~i~ion cleanout (Y/N) ¥' '~ Depression (Y/N) High water alarm.~('~/N)' '~(.'A-:; =~ ;.'·, ~ Alarm teSted (Y/N) (~. f~ . Date of pumping ; , ~/2¥/9 ~_ -..', ,- ' Pumper ',. .o . , :, . ~ .,. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I~e,'" ~',:~'~ ', ¢:~,' .~ 0~ ~'jacent lots To property line ~"~ ' Absorption field Surfacewater/drainage. ;> ~c'o* 72-026 (Rev. 7/91) Front Foundation '~' 'Water main/service line ~ ,-~'~ ' ro~t~oel~ ~, ~' CONTINUED ON BACK PAGE C. LIFT STATION I~. Date installed Size in gallons .. Vent (Y/N) .*. '* ' Manufacturer Manhole/Access (Y/N) '!Pump on" level at ' ' "Pa p off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: - Well on lot. * * On adjacent lots D, ABSORPTION FIELD DAT~ ( ;Date installed 5'/' I~' / 7'7 .... :. Length - ~/' Width '3' ¥.., · :' Total absorption area 3~ ~ ~. :. Depression over field(WN) ~ ' Results (pass/fail) -- ' Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 'Well0n I~t ' I~' On adjacent lots surface ~vater TO buildir~g fou~datio~ ~' Onadjacentlots ~ ~o° Surface water :~ too' d~ain No~ :'.5~e~ ' ' :~ ..... Curtain E. ENGINEER'S CERTIFICATION To existing or abandoned system on lot Cutbank ~v, ,4. Water main/service line '> .co ' ' '-~ "'!> So'"' :'" Driveway, parking/vehicle storage area: HAAFee$ / ~(~ '~"~)' ' ' ' ":~ Waiver Fee: $ Date of Payment /?/--Z,~ ~ ~. "' Date-df Payment- Receipt Number ,, .,'~-::)~,_ ~7~ [~"(7~2 ' "' ........ ,, ,Receip.t Number· 72-02~ (Rev. 3/91 ) Back MOA 21 - ' ' ' Engineer's Name I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on/he date of this inspection.' . . , ~ ~ ' : ',' . ...... ~~l,.' '" ' · ' ' signature P~ope~ty line Soil rating lie c~'/l~_~r,~ System type Gravel thicl~es~ ' -' Total depth Clean'0u~s present (Y/N) . Date of adequacy test 3'/E for _R bedrooms if ~,es,'give d~te ''' h', ,4,'' CHEMICAL & GEOLOGICAL LABORATORY . A DIVISION OF COMMERCIAL TESTING & ENGINEERING Co.. * · ~633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANAETSIS ~SULTS for II~10IC£ t 52070 Che.'~.ab P, ef.! 92.1077 Sar~le ! 2 I~atrix: t~ATE~ Client Sa=pie ID : LOT 2 DES[I~TO PWSID : UA Collec:e~ : gAR 20 92 ~ 10:45 hxs.. ~ecelved : FAR 20 92 ~ 12:30 Client ~a~e :FLATTOP TECENICAE $~V' Client lcct :[LATTOT ~P0t : PO8 :NON~ hECEIVED Beq! : Or~eze~ B~ : Analyfia Comple:e~ : gA~ 23 92 Send Repozts to: ~,oleased By : ~, ..~. . ~ , ~ ,. , ..... ,~ ....... ~ ...... ~J a,., . , - ..... ,. . . Parameter Betults U~t~ Rothod Allo~a~le NITP, ATE-N 0.87 ~/1 EPA 353.2 Sample ROUTItIE SAM3LE COLLECTED RI: NA- Not Analyze~ ET-Leas Than. ST-Gzeatez ~S~'~$ Member of the SGS Group (Soci~t6 G~n~rale de Surveillance) MUNICIPALITY O;: ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. ©; ! ::,'.LTH /~,~)~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~I~IiEON?/.:NTAL ENVIRONMENTAL ENGINEERING DIVISION I~.4AY ~, Telephone REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE DIRECTIONS: Complete ell part~ ~m page 1. incomplete ~lqu~ will nm be~m~llld. Plea~ allow ten (10) day~ for MAILING ~ ~, ~ LEGAL DESCRIPTION ~T~EET LOCATION TYPEOF RESIDENCE [~NGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUl~_ L¥ r [] COMMUNITY [] PUBLIC UTILITY 8, BEWAGE 01~$POSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other [] Two [] Five ~ Three [] Six * ATTACH WELL LOG. A well Io9 is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) If system is over two (2) year~ old an ad~u-acy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72,010(3/'78) --- :! THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF REsIDENcE NUMBER OF BEDROOMS I--'l SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR ' [] SIX PERMIT NUMBER 2. wATER SUPPLY I--I INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY '~'-~ 7'-~ Connection Verified INSTALLER []Sept~c]ta~ or [] Holding Tank Size: I c,-- If Tank is homemade SOILS RATING give dimensions: ''* / / ~"' TYPE OF TANK MANUFACTURER //~~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank _iI ........ ' WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS PPROVED FOR BEOROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Ti~ef') LEGAL DESCRIPTION 72-010 (Rev. 3/78) UNICIP^L,T ANC.ORA E //~;;,~'% \, DEPARTMEN~ OF HEALTH AND ENVIRONMENTA ,'PROTECTION ~~,~ ): 825 L Street, Anchorage. Alaska 99501 ~ t"~ ~ ,.~' Date Received: Septe~er 7, 1979 ~1: Time ~ Q2: Time 93: Time Date /~-]-qq ~2j. Date Date Insp ~)~j. Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchoraa¢ Mailing Address: Post Office Box 4-2090 99509 Phone: 279-1924 2. Property Owner: ~4~L,~_~(~,~_~.~ ~_~%~ Phone: Mailing Address: ~_(~ ¢~ ~..~_ 3. Legal Description: Lot 2 De'sPiritoSubdivision 4: Single Family Residence: ~ Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Se Well System: Permit # Construction Individual well ~ Community/Public System ( ) Depth of Well Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System e Public Utility ( ) Permit Septic Tank Size Absorption Area ~istances: Well to Septic Tank ,; to'.Sewer Line /O-/- Nearest Lot.line to Nearest Lot Line Installed 1977 Installer (C) O Manufacturer ~ 4 Soils Rate ' '~ Material to Absorption Area / ~' A~sorption Area MUNICIPALITY OF ANCHOPAG~ DEPT. OF · : ._ ..,('~ Municipality of Anchorage . ~ ;N~,iRONM;NT~.HC-ALTH. & DEPARTh._NT OF HEALTH & ENVIRONMENTALrpR(.,..,:CTli~:N' FF:OT[CTtON POUCH 6-650 ANCHORAGE, ALASKA 99502 'SEP ? 1977 279-2511 · REOUEST FOR APPROVAL OF INDIVIDUAL SEWER ANO WATER FACILtTIE~ ~ ~,_ ~_ j ~,./ ~ U 1. TYPE OF LOAN f-] VA r-I F.H.A. ~ C0NV 3. LEN01NG INSTITUTION ~:,4~1~: First National Bank of Anchorage A~O~ES~: P.O.Box 4-2090 Anchorage, Alaska. 99509 A~T~: gna M. Bennett PiJ:?~: 279 1924 5. SELLER [~I TI Iii ?, EL%!i : None 7. LEGAL DESCRIPTION Lot 2, De Spirito Subdivision 2. ASSESSORS PARCEL NUMBER 4. REALTOR OR AGENT ~ ~ ,.o None 6. BUYER :~,~L .... BUKOWSKI, Arthur E. & Marcia J. ....... t~,.~. E. 99th & Main Tree A~dhorage, Alaska. r~2__ 5522 E 8. LOCATIONISTRE~~ ~a1~ T~ee & 99~h Avenue 9. TYPE OF DWELLING E~ SINGLE FAMILY RESIDENCE 3 BDRMS r-i MULTI-FAMILY RESIDENCE BDRMS 10. WATER SUPPLY i-1 PUBLIC UTILITY [] PRIVATE ON-SITE 11. SEWAGE DISPOSAL SYSTEM I'-I PUBLIC UTILITY ~ ON-SITE 1977 YEAR INSTALLED 2. Remove the carbon DATE RECEIVED INSTRUCTIONS TO REQUESTOR 3. Send to address above 1. Complete Items 1 to 11 above DATE OF INSPECTION TIME OF INSPECTION TYPE 5. Response will be returned to lending CONSTRUCTION 4. Please allow 10 days for processing institution DEPTH IYEAR FT.J BACTERIAL ANALYSIS INSTALLER TANK SIZE YEARINSTALLEDI I INSPECTOR DRILLED J J LAB REFERENCE NO. JMANUFACTURER DIMENSIONS CRIB CONSTRUCTION [] PIT TOTAL LINE LENGTH TRENCH DEPTH GRAVEL DEPTH r'l DISPOSAL FIELD FT. FT. TOTAL ABSORPTION AREA /PERMIT REFERENCE SQ. FT. PERMIT REFERENCE 72-010 (I 1/76) SEPTIC TANK '.: _ , ...,~ORPTION AREA - SEWER LINES :',. LOT LINES OTHER , SEPTIC TANK ABSORPTION AREA WELL ABSORPTION ._ LOT LINE FOUNDATION TO ..~ ..... , . ~ , -., , SYSTEM TO: APPROVED D Cg~DITION.A~APP~OV~ ,~ DISAPPROVED ~ UNABLE TO INSPECT : DATE INSPECTOR I 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. DATE SIGNATURE ~-~. MunicipalitY of Anchorage .~ DEPARTI, .~T OF HEALTH & ENVIRONMENTAL PRC. ~'CTION · POUCH ~650 /~NcHORAGE, ALASKA 99502 279-2511 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES TYPE OF LOAN I-1 VA I-I F.H.A. I~ C0NV r-I J2. ASSESSORS PARCEL NUMBER 3. LENDING INSTITUTION ~/,~,~i~.: Ftro~ National ~ank of Anchorage ~ t~[~: P.O.S~ ~-2090 ~e~rage~ ~. 99509 ~;~: U~ ~. ~tt ?HC~: 279 1924 4. REALTOR OR AGENT ~/~J~: ~: 5. SELLER PHC F~[: 6. BUYER t'mr,~[: BU~OI~Si~I, Arthur E. & Harcia J. A:~D;:!:5',;: Z. 99th & Hain Tree Anchorase, A~aska. [I~',' P~.,~ ..... m?~¥ .~ ....:: 272 5522 ~zt 36 7. LEGAL DESCRIPTION 8. L0CATION/STREETADDRESS Lot 2i De Spirtt~ Subdivision Hain Tree & 99th Avenue 9. TYPE OF DWELLING E~SINGLEFAMILY RESIDENCE 3 BDRMS [] MULTI-FAMILY RESIDENCEs. BDRMS 10. WATER SUPPLY r"l PUBLIC UTILITY [:][ PRIVATE ON-SITE I1. SEWAGE DISPOSAL SYSTEM I-1 PUBLIC UTILITY ~ ON-SITE 1977 YEAR INSTALLED TYPE: DEPTH: DATE RECEIVED CONSTRUCTION BACTERIAL ANALYSIS DATE INSPECTED YEAR INSTALLED INSTALLER ~--- SEPTIC TANK SIZE MANUFACTURER [_1 DIMENSIONS CRIB CONSTRUCTION TOTAL ABSORPTION AREA: .k,- [] SEEPAGE PITS: ~ TOTAL LINE LENGTH I-I DflAINFIELD: . so. ~T. ~- WELL TO: ~ FOUNDATION TO: ABSORPTION AREA T0: . k- E] APPROVED [] CONDITIQRALLY APPROVAL VALID FOR ONE YEAR APPRO~tED FROM: [] DISAPPROVED [] ,UNABLE TO INSPECT Department of Health & Environmental Protection Page 'TwoTM ' D~partment of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 De Spirit Subdivision Comments: 2~__.-g~.~ .~~ ~.~0~ ~ ~ Affadavit Attached Disapproved: Letter Attached: ( ) Date: Department Worksheet: