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HomeMy WebLinkAboutPREUSS #2 BLK 1 LT 12'050 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: OSP241220 Work Type: Septic Renewal Tax Code Number: 05057116000 Site Legal Address: PREUSS #2 BLK 1 LT 12 G:0056 Site Mailing Address: 20252 DAVID AVE, Eagle River Owner: CARBAUGH KATHRYN C Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/5/2024 8/5/2025 25181 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 Received By: Issued By: Date: Date: V 40 3 ON -SITE SEPTICMELL PERMIT APPLICATION Parcel I.D. 050-571-16 Property owner(s) Kathryn Carbaugh Mailing address 20252 David Ave. Eagle River, AK Site address 20252 David Ave. Eagle River, AK Phone: 907-343-7904 Fax: 907-343-7997 Day phone 907-240-3854 A0 Legal description (Sub'd., Block & Lot) Preuss : BLOCK 1, LOT 12�l Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) R (w/wo ADU) Septic Tank FxJ Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings F1 Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Drainfield into slope contours & lot line waiver Distance: 0' & 4' 1 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: 1 Lis Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. 05 P2 12 20 Waiver No. GADevelopment Services\Buildlng Safety\On Site Water and Wastewater\Forms\Client Forms\Perrnit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241220, Curtis Townsend, 08/05/24 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: OSP231205 Work Type: Septic Upgrade Tax Code Number: 05057116000 Site Legal Address: PREUSS #2 BLK 1 LT 12 G:0056 Site Mailing Address: 20252 DAVID AVE, Eagle River Owner: CARBAUGH KATHRYN C Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �»cnr 04 :<}. De partme►it 7/28/2023 7/27/2024 25181 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 Received By: v� C��Ls✓ Date: I Issued By: Date: 2 g 1 3 OVIUMCIR PL Y OF A Ntom, t�3 Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section " Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-571-16 Property owner(s) KATHRYN CARBAUGH Day phone 907-240-3854 Mailing address 20252 DAVID AVE., EAGLE RIVER, AK 99577 Site address 20252 DAVID AVE., EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) PREUSS #2; BLOCK 1, LOT 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x Septic Tank Q Upgrade ❑ (w/wo ADU) (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: DRAINFIELD INTO SLOPE CONTOUR & LOT LINE WAIVER Distance: 0'/4' 1 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: Date of Payment: Date of Payment: Receipt Number: 0 Receipt Number: Permit No. Waiver No. 0S U' Z 3 u �^ GMevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 0 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231205, Curtis Townsend, 07/28/23 - � Municipality of Anchorage Department P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231035 COSA#: Permit#:OSP231205 PID#: 050-571-16 Legal Description: Preuss #2 Block 1 Lot 12 Engineer: Jeff Garness Your request for a waiver of the required 10 foot horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 4 feet. In addition, your request to install the drainfield perpendicular to the slope contours is granted. This waiver approval applies to the proposed absorption field. 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: 2g 2.92 C Date: Approved by: Name of Reviewer .............................................. 0 ■ ............................. ■ 1 **** VARIAN C E/WAIVER REVIEW **** Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231205, Curtis Townsend, 07/28/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231205, Curtis Townsend, 07/28/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231205, Curtis Townsend, 07/28/23 Ln TOE J m v i (1)c EccwE 4%41 C),'--, -©mhS E N "N-0� L tVJ�lti S/Sb8 - ' o 3 0 f-(WO919k x M.00 , 0 s (H) 9P718L M.00.9006.8fl o©ON 0 .c ..�. 2 � o v 3 ...� Luo CU (D `.' o N 4) 4w# m 4-0 m LO OHO Of4t] F -.r :03 cl. Cc: 6 :3 OtAu ,- C; o v � m u otw��' V8 +- - I o W Mn c a� m c a) VP9 C* Ln k JJ! t Qj `[[ i� ca p Z5 0 Ei --{ {? > p �a tv N U 0 E t� 73V "' {+ ! 3 +mow o.� CoLn ©>- •I -r tA Vii' ui ... �++� . u 1..' 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ZC .L ` cOOS►0 uj l D ° 0)x y, * • h . a3 © ,., c • < ` 09,Lst 8.00.,p0 000s 1 - U U. / /'� /�}A \�..r► L � ,/ 2 C 4)cn � <n .,,, �. • � � � fir! • JtA J � • �r (In } # L 2 D .� t37 0• • L Ci jpe LL LD • Q ., f 0 {{ L •( p GAIW • .... * CL • + : • c., iE -.J _AdW --o m E 0 � E 'C3 • , AMW � * • 0400- u 1+( W Vi r .* w � x c i- W QQ of c"i cr? 4 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231205, Curtis Townsend, 07/28/23 MUNICIPALITY OF ANCHORAGE DEI, ITMENT OF HEALTH AND HUMAN SERk ;S �' r Environmental Health Division D Lj 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ; ON—SITE SEWAGE DISPOSAL SYSTEMA APUD/OR WELL INSPECTION REPORT Name Fi DISTANCES a7 L FROM TO SEPTIC TANK ABSORPTION FIELD WELL Address �Z I� WELL / , Phone(s) Permit No. No. off Bedrooms G 2 LOT LINE C)C LEGAL DESCRIPTION Lot Block Subdiv L_} � FOUNDATION Township, Range, Section l \ AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, t driveway, water bodies, etc.) TANKS SEPTIC ❑ HOLDING 1 t 1 • I i Manulacturer 1 Capacity in gallonsCIO �ZC✓D:, Material ?L_�,i No. of Compartments Z 11, - -t'-]TYPE OF SYSTEMA TRENCH ElBED ❑ W. DRAIN ❑ OTHER I r f t Depth to pipe bottom from Total depth from original grade original grade A— FT O FT l f Fill added above original grade Gravel depth beneath pipe D FT FT Gravel length Gravel width Z7i FT 2 ,Z;�FT M_ Total absorption area Distance between lines Q FT FT Number of lines Soil rating Pipe material i 1 SQ FT J Installer Date Installed lt7 I� —10 !/ELLS I I t PRIVATE El OTHER (Identifv) Classification (A,B,C) Total Depth Cased to \ L'► FTJ FT I , Installei Date Installed: A' l • , � y S J�l yREMARKS: _ IS l� L—c O o Scale: to,;, p Inspections Perfor ed by: ENGQE@�S SEAL _,,; ��`?� r-4 gi k j� , Date: S & S ENGINEERING % *'S'. J' f(a�, • �` Eagle R'sver, Alaska 99577 I cert'ly that this inspection was performed according to all ;f ? a�f'z Municipal and State guidelines in eflect on 's date: �� 7 t L JJ--�C^ �h4�n e�na viz _" t���•,n;2d: �4�Y•.r«�� Health Department Approval: Date: ��,co *%,.msµ 72-013 (3/85) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 0 N - S I T E S E W E R F' E R M I T Permit Number. 87 Date Issued: 10112/87 Lip g r ad e Owner Name: J8HN AND PEGGY VANMOORT O~'nmr Address: 20252 DAVID STREE]' EAGLE RIVER, AK 99577 Parcel Id: 05()-571-16 ~ Section: 8 Township: 14. N Range: Lot Size 25181 (sq. lt. or ac~os) Max Bedrooms~ This F'epmit: 1 'Total Capacity: Day Phone: 694-4200 !SEWER SYSTEMS: Listed below are the options available to you in designing your sew[_~,r system. Choose the option that best fits your site. T R E N C H~- B E D Depth to F'ip~) Bottom (ft G~avel Depth (ft 'Total Depth (t't Gravel Width (It : Gravel Length (It : GPavol Volume (cubic yds : Soil Rating Used (sq ~t/brm): W. D R A I N : 4.0 4.0 4.0 : 6.0 O. 5 3.5 : 10.0 4.5 7.5 2.5 13.0 5.0 ~ ~ 25.0 19.0 t~. } 11.5 1~i. I 18.6 225 ~1~ LIFT STATION: If a lift station is installed, a high water alarm must be connected to the residence. SEP-r]c TANK: Minimum total s~ptic tank capacity: 1.,000 gallons. Each septic tank must have at. least R compartm~nts. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). I CERT]:FY TNA]: 1. I am tamiliar with the ['equirements for on-sit[) sewers and wells as s[?t [orth by th~ Municipality el Anchorage (MOA) and the Stato of Alaska. 2. I will install the system in accordance with all MOA codes; and regulations, and in compliance with the design criter-ia o~ this permit. 5. I wi] 1 adhere to all MOA and 8rate o~ Alaska requirements lop the set back distances [rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent, or nearby lot. 4. I understand that this permit is valid ~or a maximum el' I bedrooms. I also understand that the capaciEy all' the total ~;ystem is 3 bedrooms and any enlargement will require an additional permit. ' DATE: S ~ S ENGINEERING 1705554 E. R. LOUP t1204 EAOLE RIVER, AK V~577 PHONE II694-2979 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SEKVICES DIVISION OCT 8 1B87 RECEIVED ,ALE: :, I L.:It. ANI: ()DRESS: 10-8-8 7 VANHOORT · 20252 DAVID AVE. EA~LE RIVER ALASKA FACT PHONE: 694-4200 tzl;;Al_ DESCRIP'I']ON: LU'I 12 BLOCK I PREUSS ~2 SEC 8 , f14N,RIW tll SIZE: 25181 (SI2 FI L1F?~ AX. NUHti~ER OF [~EDRO0~IS: 1 .t.lll. RAI'INO: 225 S~ FI'/BR :(;~1_ 'f'ES'I UEP'I'H: 16 F'I 0 WA]ER PRESENI' IN 'fES'f HOLE, IHIS IS AN UPGRADE OF 1 BEDROOM TO THE EX1S'I'II,I~ SEHllC SYSIEM tCL-.C :1 Al. CONI) I '1 ! [Il'iS OR I NS"I'RUCT 10NS: llJS IS AN IJPGRADE FROM 2 BR. TO .5 BR. 1.1 AI)Et. fUACY 'lES1 FOR 2 BR, ONLY. TIdE EXISI'ING SYSI'EH PASSED PERFORMED FOR: LEGAL DESCRIPTION: ['~'1'~' ~ ~ 2 4 6- 7- MUNICIPALITY OF ANCHC 18 OCT 8 1B87 ~9 · r"" t''x,. L Municipality of Anchorage ~,_~ ~. -~.~.~j~, 825 L Street, Anchorage, Alaska99502-0650/~..~~T~ SOILS LOG -- PERCOLATION TEST~I~ ;~'-~;. DATE PE~~~ ~~ ~ Township, Range, Section: ~~ SLOPE SITE PLAN ' WAS GROUND WATER ENCOUNTERED? t'-,~O S L IF YES, AT WHAT O DEPTH? p E Depth to Water ~ ./ Menitoring? ¥~Y'-'~ Dat~ Gross Net Depth to Net Reading Date Time Time Water Drop ~,/- - 20 RECEIVE PERCOLATION RATE ~ (m~nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~:~ FT AND '~ FT IN !"*~ MUNICIPALITY OF ANCHORAGE ~' . 'IL. · .~//~'1~ ';~.~"~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION .~, 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ~ ,~N-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION ~Y DISTANCE TO: ~ Well ~ ~ ~sor i larea D~lling , Liq. ~a~c~ ~gallon, IF HOME~E: , nsid~n~h Widt~ L,quid depth ~ ~ PERMIT NO. ~OZa ~ DISTANC~ O Z ~ Manu~r · _ ~ Material ~ ~uid capacity in gallons i Foundation e Nearest lot line PERMIT N~ ~ DISTANCE TO: Well Total length o~n~s Trench ~ ,-~ ~O. ~ ~ W inches Oistancebetwee~i~ Q ~ Top of tile to finish g~ ~----~ Material beneath tile WO inches Total el f,tive~n area Len~ Width Depth PERMIT NO. ~ /~ ~ell Bu~undation Nearest DISTANCE TO: ~ ~ ~ Depth Driller Distance t~ot lin~ , PERMIT NO. OTHER PIPE MATERIALS INSTALLER 72-013 -~v. 3/78) O~-4--S I TE PERMIT t'40. ( 798892 > APF'LICRNT LOCRTI ON LEGAL rdLIt-~ I "~ I R.. tL I TY I]F Rt-4L-:.HL .;-.'1-~ r~ t- [)EPRRTr,IENT OF HEALTH AND EHVIRONIIENTRL PROTECTIOtl 825 "L' STREET, FII'i~HORAGE, RI.~.. 99581 264-4720 SEt4ER REEf'1 I T [)UNC~I f'ICLEOD DRVID STREET L12 Bi PREUSS S/E) ADD ~2 PEw BOX 795 EAGLE RIVER LOT SIZE 694 97t5 2518i SQUARE FEET TYPE OF SOIL 8BSORBTIOf'I SYSTEI'I IS: TRE/ICH 1,1RXII'IUlt. HUI,1BER OF BEDROOI,IS = _~ SOIL RATING (S.r..! FT?BR>= 228 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEF'TH= _~--. 5 LEI'-.I¢~Ttq= 6-1 r~Rf:I'-.-'EL DFPTI I~ 5. 5 THE LENGTH DIMENSIOtl IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRIr.~FIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTAf4CE BETI,EEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THERE IS NO SET I.IIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE r,IINIf4UM DEPTH OF GRAVEL BETI,IEEt. I THE OUTFRLL PIPE Pt-ID THE BOTTOt,1 OF THE EXCAVRTIO/I (IN FEET>. F-: E,_.'~-. LI I RED SEPT I C TRt-4K $ I ZF-- d E4OO 6t~LL~_-'~t-~S F'ERf. IIT APPLICANT HAS THE RESF'ONSIBILITY TO I/.IFORf,1 THIS DEPARTf,IE/IT DURING THE INSTALLATION INSPECTIONS OF ANY fELLS RDJRCEHT TO THIS PROPERTY Ri. ID THE f. IUt,IBER OF RESIDENCES THAT THE t4ELL I,IILL SERVE. TF~O ( 2 > I t4SPEOT I 0t45 RRE F;Fg!LI I RED E:ACI;'FILLING OF At-IY SYSTEr~ ~IITHOUT FI/.IRL INSPECTION RtID APPRO',/RL BY THIS DEPARTf,IENT ~IILL. BE SUBJECT TO PROSECUTION. MIt. IIMUt'I DISTANCE BETI,IEEN A I,IELL AND Rt. IY ON-SITE SEI,IRGE DISPOSAL SYSTEM IS 108 FEET FOR A PRIVATE I4ELb OR 158 TO 208 FEET FROt'I R PUBLIC I,IELL DEPENDING UPOtI THE TYPE OF PUBLIC I,ELL OTHER RECJ. UIRB{tITS t'IAY APPLY. SPECIFICRTIOI5 AND CONSTRUCTION DIAGRAI'IS PRE AVAILABLE TO IIISURE PROPER II.ISTRLLRTION. F'ERt-11 T EXF' I RES DE,~-EflBEF; 5:1 .. I ':'79 I CERTIFY THAT I: I Rtl FRfiILIRR IqITH THE REQUIREMEtITS FOR Oil-SITE SBqERS AND IqELLS AS SET FORTH BY THE f'IUtIICIPALITY OF ArICHORAGE. 2: I I,IILL INSTALL 3HE SYSTEf~ IN ACCORDAtiCE I,IITH THE CODES. ~: I UNDERSTR%qD THAT THE ON-SITE SEI4ER SYSTEf'I fqR'¢ REQUIRE Ef4LRRGEMENT IF THE RESIDENCE~IS REfIODELED TO INCLUDE ~IORE THAN ~ BEDROO[IS. R72~T~Rtl ,'ICLEOD · , O 8' E GEO,r'"ZCHNICAL El' DEVEL?PMENT CO. · Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl EJlis 694.2774 SOIL L0~ Soils ~t Foundations Land Development Perfomed for: Name: Z~c;~'~7/v' /~/,~o.~ Tel. Matltng Address: /~.¢P-/~'o~ '~'.~', ~'me;/~E ~, Leg&l Description: £o~ /~,.~zk-. // Depth (feet) o Soll Characteristic; i2 i5 16 Ground Water Encountered: Yes , Proposed Installation: Seepage Pit Comments: No /'"" If yes, what depth Drain Field Perfomed by: ~ _ _. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH 0 ~'0 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1/ GENERAL INFORMATION ' ' " ' (a) Legal Desci'iption (include lot, block, subdivision, section, towns, hip range~.-~ .*. * ' - Location (address or directions) ,' '- · . , , p nt, .- elep'~one: H,ome i~. ~ ~ Business ..... ~'~ '~' .... Applicant Address -g...~...r-~ ~ .~/.~,~/~ ~ ~ ~ ~ ~ -~_..~ ~ '"~,':=~1-1 ' ' ' ~-." -' (c) Applicant is (check o~e): Lending Institution []; Owner/builder,~E~J.;. Buyer rl; Other [] (explain); .... :,,~ ., (d)': Lending Ins, titution ' ;' Tel phone ress - ' - :~; Ad~ ,.. (e) 'R;;i Esia't'e "' Add;ess {I} ~ailthe H~ 3: S & S ENGINEERING r ' · 17034 Eagle River L--'~ Road No. 2.04 TYPE OF RESIDENCE Single-Family,S-- Multi-Family [] Other Number of Bedrooms ~ WATER SUPPLY Individual Well J~- Community [] Public ri Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. - SEWAGE DISPOSAL OnsiteJ~ Public[] Community[] Holding Tank[] Note: If community well syster~, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72.025 (11184) euoqdala£ · uo!loadsu! s!ql jo elep eql 3o/pue Xlddns Jal, e~ al!s-uo eql 'uo!ToadsuJ pue uo!le§!l, SaAu[ ,&mu. JOJj pue Sal!j e§e.Joqou¥ 1o ,~l!led!o!un~ aU1 U.JOJI . pau(elqo uo!$emJoju! aql, uo paseq 1eLI1 ,~J!JaA JaqlJnJ I 'u!aJaq pal, eo!pu! eJnlonJls jo ed~l pue su. Joo,Jpeq jo Jeqmnu etll JoJ'e..-: ':" ' &'~enbapepue euollounj'ajessH.z, JaT, s;{s esods~pda3eMalse,v. Jo/pue,{ ddns.mleMelt$-uoaqlleql. SMOqS e^oJddVXluoqln¥ ..... qlleaH s!ql lO UO!le6!lSa^u! ~mJ leql ~jpa^ I 'Molaq UMOLI$ alep UO!leP!le^ eql Jo se pue ojaJaq pax!lie leaS,(tu ,(q pa!J!lJa3 sV NOLLVlBII:IO4NI aNY VIVa 'H:31dVgS ::1-114 'SJ.S=I.L 'SNOLLO:IdSNI DNIOlAOI:id INt:II:I DNII:IggNIIDN3 'g ~MUNICIPALIW OF ANCHORAGE (MOA) ", HEALTH AUTHORI~ APPROVAL (NAA)" CHECKLIST - FEBRUARY 19~ Well Classification Well Log Present (Y,~ Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~N) Separation Distance{ fror~ Well: To Septic/H~ Tank on Lot If A, B, C, D.E.C. Approved (Y/N) ~" k;,,)J~-'-" Yield Depth of Grouting -'"" Pump Set At Sanitary Seal on Casing {~N) Depression Around Wellhead (Y/I~:) · Date Completed Cased to '~"~' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ' & ~ ; On Adjoining Lots To Nearest Public Sewer Line rJ ~ //~ · · 'To Nearest Public Sewer ' CleanouVManhole (J~, To Nearest Sewer Service Line on Lot Water Sample Collected by ~,~-7 ~.-1~-11,;,,~c:3(2~ ;Date Water Sample Test Results _ _~'~1"'1~~~ -- ~'~-~-'~--~/~, Comments /~ ~ ~-,~,~.~Z....-'~:3~,L,.-~ ~ ~ SEPTIC/H4~c'DIRG TANK DATA J/ Date Installed ~'~'Z~ Size Standpipes([:~Y)N) Air-tight Caps(:~N) Depression over Tank Pumping/Maintenance Contract on File (Y/N) ~ i Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Hotd~ Tank: To Water-Supply Well ~ ~:3{:~ I To Property Line . ~----~' TO waier Main/Service Line Course ~ c~ Comments '~..~-~ No. of Compartments ~ Foundation Cleanout ~:~) Date Last Pumped ~1 ~ Hz~- ~i~"7 r'3/~/ ; for '~' Temporary Holding Tank Permit (Y/N) ~'"~/~ ! To Building Foundation ', \~')... To Disposal Field "'~" ': ' '~c::)l. ' '" - ' '" ~ ,~ ~'"~'1 To Stream, Pond, Lake, or Ma]or Drainage Page 1 of 2 72-026 lR~'v 8'86~ F~ont C. ABSORPTION FIELD DATA Soils Rating i.n Absorption Strata Date Installed Width of Field ~,~'~~ Type of System Design tc,//~/8,7 Length of Field _ ~ / Depth of Field Gravel Bed Thickne~ Standpipes Present Square Feet of Absorption Area Depression over Fie, ld (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~-~::~ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments -')~-' 1 i~-~--'[:::), ~:' ~.-~ Date of Last Adequacy Test I c::~l,~. I To Property Lir{e ' ~,~' To Existing or Abandoned System on .~::~l..j~ To Cutbank (if present) Date Size in Gallons ~"~ "Pump On" Level at Dimensions Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Vent (Y/N) ~~urin Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HSA guidelines in effect on the date of this inspection. Compa~0e34 Eag: Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 trey 8~861 Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IClPALITY OF ANCHORAGE ¢_---- 825 L S,,~- A~ho.~. A~ 99~1 DEPT. OF H:ALTH & (~) [~I~ON,V~NTAL p~,CTE~ION ENVIHON~ENTAL ENGINEEHING DIVISION Telephone ~720 REQUEST FOR ~PROVAL OF INDIVIDUAL WATER ~D SEW~ t~l~ D DIRECTIONS: Complete all ~s on pe~ 1. I~o~le~ ~u~ will n~ ~ pr~. ~l~ t~m tin (I0) ~ ~r p~ing. 1. PBOPERTY ~NER ~~ PHONE MAILING ADDRE~ ~RODERTY RESIDENT (If different lrom ~bo~) ~ .... PHONE ADD· L~D~Nfi INSTITUTION ] PHONE H MAILING ADDRESS ~ ~ALTORIAGENT MAILING ADDRES~ 5. LE~IAL DESCRIPTION ..... Lc,';'/- I,q'3UL". rP} ue. STREET LOCATION ' 5. TY~ o~ ~m~Ncs NUMS~R OF  One ~ Four ~ SINGLE FAMILY Two ~ Five ~ MULTIPLE FAMILY Three D Six [] Other 7. WATER SUPPLY ~' INDIVIDUAL* * 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.) '8. SEWAGE DISPOSAL SYSTEM .~ INDIVIDUAL/ON-SITE** **If individual/on-site, 9ive installation date If system is over two {2} years old an adequacy test is required [] PUBLIC UTILITY 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 ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE . NUMBER OF BEDROOMS "~ SINGLE FAMILY [] ONE ~ THREE [] FIVE I--I OTHER I-'1 MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~'i- '~.~';'~ Connection Verified INSTALLER ~]SepticTankor []HoldingTank . .. Size:,~-$~--~ If Tank is homemade SOILS RATING give dimensions: "~.'~ ~) TYPE O F.-T.~A N K . MANU FAC~Ri E,,R MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS rt'q'"'/APPR OV E D FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE I~Y (Title) ('~, , LEGAL DESCRIPTION 72-010 (Rev. 3/78) " MUNICIPALITY O~ANCHORAGE DEPT. CZ: '~L~H  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~IO~' ~/' ~' ~.~,.~dA~ F;,~ I~CTION 825 L S~ - A~o~, A~ 99~1 SEP~ '~ ~79 ENVIRONMENTAL ENGINEERING DIVISION R E C E i V E D REQUEST FOR ~PROVAL OF INDWIDUAL WATER AND SEWER FACILITIES '. PROP~NER~ . . / PHONE PROPERTY RESIDE~ Jif differ~t from a~, i / PHONE ~ auY~ .// / PHONE MAI LING ADORE~ ~ ~ LENDING INSTItUtION ~ ~LTOR/AaENT . , I PHONE 6- LEGAL"I~ESCRIFTION STREET LOC~,TION · .~ 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four r'-I Other ~ SINGLE FAMILY 1~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six WATER BUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY · 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.) SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INsPEcTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SlOE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME GATE DATE GATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS -~ SINGLE FAMILY I-1 ONE '~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER ~ INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRI LLE D [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~ INDIVIDUAL/ON -SITE GATE INSTALLED Connection Verified INSTALLER ~[~]Septi'--~c Tank or []Holding Tank ~{~ Size:~ If Tank is homemade SOILS RATING give dimensions: ~ TYPE OF TANK MANUFACTURER TOTAL A~SORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line WELL TO: I I Absorption Area to neerest Lot Line 5. COMMENTS ~ APPROVED FOR ~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72.010 IRev. 3/78)