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HomeMy WebLinkAboutCOHOE LT 9Onsite File Cohoe Lot 9 #015-051-21 k .— Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211264 PID Number: 015-051-21 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name Richard C Benjamin Jr ABSORPTION FIELD Q Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 9321 Strutz Ave, Anchorage, AK, 99507 ❑ Other Phone 240-9239 Number of Bedrooms 4 Soil Rating Total depth from original grade 4.0 GPD/SF 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4,0 Ft. Gravel depth beneath pipe 5.0 Ft. Subdivision Cohoe Block Lot 9 Fill added above original grade 0,0 Ft. Gravel length 17 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 170 Ft2 Ft. Well N/A (� � /� 1 V�/ 1 N/A N/A >25 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding F�] Other Manufacturer Orenco/Advantex Capacity 1500 Gal. Surface Water >50' >50' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >5' N/A N/A NA .Foundation >10, >10, N/A N/A LIFT STATION cturer Capacity Remarks Gal. Alarm location installed by Installer PIPE MATERIAL House to tank D3034 Tankto drainfield D3034 Northern Excavation Drainfield D3034 CO/MTD3034 Inspector L. Tidwell BENCH MARK (Assumed elevation) 100 ft Inspdection 151 9/8/21 9/10/21 Location and description aro 2 n Bottom of siding @ point "A" 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �� Conditional Approval: Date ... •. •tQ 49 TH • Septic System/� �••` Benjarrinchiller •:� ��'sr•., Approved l�?��,�6�{' Date 13 �2 1%12/222 pROPROR FESSIQN Note: this approval does not include well permit requirements. � . k .— x x x x x x x x x // // // O/EO/EBenjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEER1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT EIP - ELECTRICAL INSP PIPE DV - DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH-1991 PERMIT # OSP211264 PID # 015-051-21 COHOE SUB, LOT 9 A B 2CO1 18.0 MH 20.4 2CO2 25.7 A B DV 27.2 CO1 31.0 MT 43.0 CO2 45.6 33.5 34.0 32.1 33.4 29.5 21.6 19.3FEET 0 30 60STRUTZ AVENUE3-BDRM HOME 1/12/2022 10' UTILITY EASEMENTADJACENTSEPTIC AREAADJACENTSEPTIC AREANEW 15' LONG x 3' WIDE, 5' EFFECTIVE DEPTH ABSORPTION TRENCH 13' MIN SEPARATION FROM EXISTING FIELD CONFIRMED AT CONSTRUCTION 10' NEW 1500-GAL ADVANTEX FAP 2.0 TANK EXISTING TANK REMOVED & DISPOSED OF MT CO1 CO2 EAST EXISTING TRENCH TO REMAIN IN SERVICE FOR ALTERNATE SITE 13' 3 9 5390200' COMMUNITY WELL RADIUS POD DV 2CO2 ABANDONED TRENCH APPROXIMATE WATERLINE LOCATION PLAN AS-BUILT EIP2 EIP1 2CO1 MH EIP1 23.2 EIP2 34.6 28.3 18.3 NOTE: EIP1 & EIP2 ARE FOR THE MUNICIPAL ELECTRICAL INSPECTOR THEY ARE NOT FUNCTIONING COMPONENTS OF THE SEPTIC SYSTEM PROFILE AS-BUILT (NO SCALE) 17' DRAINFIELD ROCKMT TH-1991NO GROUNDWATER TO 85.5 ON 10/28/91 91.0 96.0 COCO83.5 91.0 96.0 100.0 ORIGINAL/FINAL GRADE Benjamin Schiller CE 12592RE GISTEREDPROFE S S I O N A LENGINEER1/12/2022 PERMIT # OSP211264 PID # 015-051-21 COHOE SUB, LOT 9 1500 GAL ADVANTEX FAP 2.0 TANK AX-20 FILTER POD 95.3 90.32COMH 2CO99.3 I I 25.0' I a Lot 10A N 89'59'00"E 1 1 STORY RESIDENCE N w/ DAYLIGHT BSMT. 50.2' S 89'59'00"W 14 J J Lot 8 j 50.2' 11.1' I O / � SEPTIC PIPES-' /V/�/� MANHOLE `TREATMENT POD Lot 9 9,245 S.F. ).08' CHAIN-LINK FENCE � 10' UTILITYJ EASEMENT NOTE: LOT IS SERVED BY A COMMUNITY WATER SYSTEM. Lot 5 FENCE . Z ... 3.0'x14.4• 0 O 2.9x1 1.0' m 00 PORCH O � N J m m D o O m�0 ASPHALT W DRIVEWAY M O M I rlq G� Lot 10A N 89'59'00"E 1 1 STORY RESIDENCE N w/ DAYLIGHT BSMT. 50.2' S 89'59'00"W 14 J J Lot 8 j 50.2' 11.1' I O / � SEPTIC PIPES-' /V/�/� MANHOLE `TREATMENT POD Lot 9 9,245 S.F. ).08' CHAIN-LINK FENCE � 10' UTILITYJ EASEMENT NOTE: LOT IS SERVED BY A COMMUNITY WATER SYSTEM. Lot 5 FENCE Lot 6 0' T&E EASEMENT PLOT PLAN ___ AS BUILT _X_ SCALE _1___30__ GRID _ SW 2437__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone Q000OpO (907) 522-4625 Fax Professional Land Surveyors ken®Iangsurvey.com o � F A.._ q jonathan®langsurvey.com O®� A '•St�i1. I hereby certify that 1 have surveyed the following described property: �' ' LOT 9, COHOE SUBDIVISION (PLAT No. 70-169) * 4.. Anchorage Recording District, Alaska, and that the improvements situated thereon are �...,•. 49TH -9 within the property lines and do not encroach onto the property adjacent thereto, that O no improvements on the property lying adjacent thereto encroach on the surveyed 0'A :•'KENNET G. L4 t premises and that there are no roadways, transmission lines or other visible o 0 o easements on said property except as Indicated hereon. t0 9F '..LS -5202..' yJOG Dated this the __ � �^Day of __ i, L-_! i____-__, -- at Anchorage, Alaska 4p O pR �O o 04o OFfSSIONAL m� It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Ln 0 0 m O O � o m m m o O m�0 Lot 6 0' T&E EASEMENT PLOT PLAN ___ AS BUILT _X_ SCALE _1___30__ GRID _ SW 2437__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone Q000OpO (907) 522-4625 Fax Professional Land Surveyors ken®Iangsurvey.com o � F A.._ q jonathan®langsurvey.com O®� A '•St�i1. I hereby certify that 1 have surveyed the following described property: �' ' LOT 9, COHOE SUBDIVISION (PLAT No. 70-169) * 4.. Anchorage Recording District, Alaska, and that the improvements situated thereon are �...,•. 49TH -9 within the property lines and do not encroach onto the property adjacent thereto, that O no improvements on the property lying adjacent thereto encroach on the surveyed 0'A :•'KENNET G. L4 t premises and that there are no roadways, transmission lines or other visible o 0 o easements on said property except as Indicated hereon. t0 9F '..LS -5202..' yJOG Dated this the __ � �^Day of __ i, L-_! i____-__, -- at Anchorage, Alaska 4p O pR �O o 04o OFfSSIONAL m� It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Sox 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: {907}343-7904 Fax: (907) 343-7997 http-./Av w.muni.orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP211264 Work Type: Septic Upgrade Tax Code Number: 01505121000 Site Legal Address: COHOE LT 9 G:2437 Site Mailing Address: 9321 STRUTZ AVE, Anchorage Owner: BENJAMIN RICHARD C JR Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: �o�ment'�� r. [] n v Department Lot Size in Sq Ft: Total Bedrooms: 7/12/2021 7/12/2022 9245 Q Disposal Field 0 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 (2417). 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: Standpipes for field to be abandoned shall be located to confirm minimum 13 ft separation to new field. All standpipes for existing drainfields are to be found and either extended to grade (for fields) to remain) or abandoned properly. Veronica Pope GE 2021.07.12 Received By: . ° ° 12:16:36 -08'00' 1 Issued By: LdUL�_ Date: f Date: I ,2 3 MUNICPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-051-21 Property owner(s) Richard C Benjamin Jr Day phone 240-9239 Mailing address 9321 Strutz Ave, Anchorage, AK, 99507 Site address Same Legal description (Sub'd., Block & Lot) Cohoe Sub, Lot 9 Legal description (Township, Range & Section) Lot Size 9,245 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo AD U) Septic Tank MUpgrade FX Duplex (D) El Holding Tank ElRenewal ❑ 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: 5 Date of Payment: `7 7 b O � 1 Receipt Number: o,7 b (0 a Permit No. 05PZ1 12 6 �{ Permit App__-: ,_.,:c: Waiver Fees: Date of Payment: Receipt Number: Waiver No. July 9, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 7/9/21 Subject: Cohoe Sub, Lot 9 – 9321 Strutz Ave Septic system replacement Dear On-Site Services Engineer: The owner of the above lot intends to sell a 3-bedroom home on the property and the septic is in failure. We are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well as the proposed and existing septic location. No conflicts exist between this proposed system and any other well or septic system on adjacent lots. The ground surface on the lot is nearly flat. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The subdivision is serviced by a community well and the 200’ well radius is shown. The new system will be a minimum 13’ from the existing septic fields, 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211264, Rebecca Carroll, 07/12/21 x x x x x x x x x // // // O/EO/E1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH-1991 COHOE SUB, LOT 9 FEET 0 30 60 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 50' OF THE PROPOSED SEPTIC SYSTEM CLASS A WELL SERVES ALL LOTS IN SUBDIVISION. WATER LINE TIES INTO THE SOUTHWEST SIDE OF THE BUILDING.STRUTZ AVENUE3-BDRM HOME July 9, 2021 10' UTILITY EASEMENTADJACENTSEPTIC AREAADJACENTSEPTIC AREA15' LONG x 3' WIDE, 5' EFFECTIVE DEPTH ABSORPTION TRENCH MAINTAIN 13' MIN FROM EXISTING FIELD 10' NEW 1500-GAL TANK w/ 20" MANWAYS & AX-20 ADVANTEX FILTER POD MT CO CO EAST EXISTING TRENCH TO REMAIN IN SERVICE FOR ALTERNATE SITE NOTE: RECORDS INDICATE A CRIB WAS ABANDONED IN AN UNKNOWN LOCATION. IF LOCATED IN NEW TRENCH LOCATION, REMOVE & BACKFILL w/ IN-SITU NON-ORGANIC MATERIAL. 13' 3 9 5390200' COMMUNITY WELL RADIUS POD DV 2CO ABANDON WEST EXISTING TRENCH REMOVE STAND PIPES & CAP OFF AT INTERSECTION POINT DECOMMISSION EXISTING TANK PER UPC APPROXIMATE WATERLINE LOCATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211264, Rebecca Carroll, 07/12/21 COHOE SUB, LOT 9 TYPICAL TRENCH SECTION (NO SCALE) 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 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 3' 6" 6" 3' 6" 5' DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 20 MIN/IN APPLICATION RATE: 4.0 GPD/SF 5' DEEP TRENCH SYSTEM 1500-GAL SEPTIC TANK w/ 20" MANWAY & AX-20 ADVANTEX FILTER POD BOTTOM OF TRENCH: 9' BELOW GRADE FLOW LINE ELEVATION: 4' BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE 450 GPD / 4.0 GPD/SF / 5 DEEP / 2 SIDES = 11.3 LF TRENCH REQUIRED (15 LF SPECIFIED) June 25, 2021 GEOTEXTILE FABRIC Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211264, Rebecca Carroll, 07/12/21 M Z C M I 25.0' _ I Lot 1OA N 1 STORY RESIDENCE wl DAYLIGHT BSMT. S 89'59'00'V✓ 1 Lot 8 WOODEN FENCE Lot 9 9,245 S.F. PIPES -CHAIN-LINK I FENCE 10' UTILITY EASEMENT Lot 5 CHAIN-LINK FENCE Ln .. Z - -.. p 3.0'x14.4' p O - 2.9'x11.0' ' Q N PORCI- p 28.5' m V Lot 1OA N 1 STORY RESIDENCE wl DAYLIGHT BSMT. S 89'59'00'V✓ 1 Lot 8 WOODEN FENCE Lot 9 9,245 S.F. PIPES -CHAIN-LINK I FENCE 10' UTILITY EASEMENT Lot 5 CHAIN-LINK FENCE Ln 6.0 -.-ASPHALT p DRIVEWAY O N N p o 28.5' Lot 1OA N 1 STORY RESIDENCE wl DAYLIGHT BSMT. S 89'59'00'V✓ 1 Lot 8 WOODEN FENCE Lot 9 9,245 S.F. PIPES -CHAIN-LINK I FENCE 10' UTILITY EASEMENT Lot 5 CHAIN-LINK FENCE 11 Lot 6 T&E EASEMENT I NOTES: 1) LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 2) SEPTIC PIPES WERE CUT OFF BELOW GRADE AT TIME OF SURVEY. PIPES SHOWN HEREON ARE A REPRESENTATION OF SEPTIC SYSTEM AS—BUILT FROM AUGUST 11. 1992. MORTGAGE SURVEY _X_ SCALE _ 1=_= 30__ GRID SW 2437Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000��p4� (907) 522-4625 Fax o Professional Land Surveyors kenOlangsurvey.com c DF.!q.q�44 jonothanOlongsurvey.com O S Q I hereby certify that I have surveyed the following described property: O'r LOT 9, COHOE SUBDIVISION (PLAT No. 70-169) 0* 49TH Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a �'t' ......... . . . ..0 representation of the conditions that were found on the date the survey was performed. Q Y This survey does not constitute a boundary survey and is subject to any InaccuraciesQ rrtt" that a subsequent boundary survey may disclose. The information contained hereon shall ��, KENN AN o G not be used to establish any fence, structure, or other improvements.(pIL�2i �- 0 aF '.LS -5202. 'gJpO Dated this the __ ____ Day of --- L- ------------ Z__L I, at Anchorage, Alaska 4��4�gaFE......SIONPIL It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Ln o p m O p o A m m n p 11 Lot 6 T&E EASEMENT I NOTES: 1) LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 2) SEPTIC PIPES WERE CUT OFF BELOW GRADE AT TIME OF SURVEY. PIPES SHOWN HEREON ARE A REPRESENTATION OF SEPTIC SYSTEM AS—BUILT FROM AUGUST 11. 1992. MORTGAGE SURVEY _X_ SCALE _ 1=_= 30__ GRID SW 2437Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000��p4� (907) 522-4625 Fax o Professional Land Surveyors kenOlangsurvey.com c DF.!q.q�44 jonothanOlongsurvey.com O S Q I hereby certify that I have surveyed the following described property: O'r LOT 9, COHOE SUBDIVISION (PLAT No. 70-169) 0* 49TH Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a �'t' ......... . . . ..0 representation of the conditions that were found on the date the survey was performed. Q Y This survey does not constitute a boundary survey and is subject to any InaccuraciesQ rrtt" that a subsequent boundary survey may disclose. The information contained hereon shall ��, KENN AN o G not be used to establish any fence, structure, or other improvements.(pIL�2i �- 0 aF '.LS -5202. 'gJpO Dated this the __ ____ Day of --- L- ------------ Z__L I, at Anchorage, Alaska 4��4�gaFE......SIONPIL It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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 4� Day of L -,e' of 20Z/ , by and between 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 follo'kvs: 1. Advanced Wastewater Treatment Systems The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex Waste Water Treatment System located at (legal description) Cohoe Sub, Lot 9 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout 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 repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (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. K-16 Owner acknowledges that regular maintenance of an AW'ViTTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 ZEOwner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. -9 Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be 1-� 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 I 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. u , 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 OWNIM: fry: Syl'`l,�C-L'.-�-_�(signatt�re) Date: �`' � 12-1 f �'iFtff /I A'e ll' IT -r-t I =` f 7,r (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this /6 ay of 20 2-1, by /Zr c.prn2D MUNICIPALITY: By: �(4�kO (signature) &' rro ( (print name) Date: Title: (rev. 05/18/2018) Page 3 of 3 Municipality of Anchorage Page I of .~___ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 6~6'~O~.~ PIDNumber: Name: ~t~.~A~l~ · ~tCH~ ~ Wastewater System: D New ~pgrade Address: ABSORPTION FIELD Phone: ~ No. of Bedrooms: ~eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION sci, Rating: Lot: Block: Subdivision: Depth to pipe bottom from originai grade: Gravel depth beneath pipe Township:~~ Range~ Section:~ Fill added above original__grade: Ft. Gravel~length:~o ~ ~ Ft. WELL: ~ New ~ Upgrade Gravel ~ Number of lines: ~Distance between lines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level:Ft, Installer: ~ Yield: GPM ~Pump Sot at: Ft. ]Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~Se,t,c ~ HoU~ng ~ S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~C~ . ~H [~ J O O D Material: Number of Co~a~ments: Surface ~ -- -- -- -- LIFT STATION Water LineL°t ~O ~ 0 -- ~ -- Size in gallons:I~ Manufacturer: Foundation ~ ~ __ -- -- "Pump °n" level at: I"Pump°ff"levelat: IHigh water alarm at: Curtain Pump Make & Model ~ Electrical Inspections pedormed by: I Remarks: BENCH MARK e~ ~ ~~ [~~ , Location and Description: I Assumed Elevation: Inspections performed by: ~ Dates: 1st Department of Hea H~ [vices appr~l/ Reviewed and approved b ' ~Date: 72-013 (1/91) MOA 25 99.4 F99'~ --X - '-X 99,8 99,8 TBBBEN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH, AK, 99501 30 45 SCALE; J' = 30 FT, LO 9 'HO, ~$£1 $IPOIZ bV£NO£ SEPTIC SYSTEM AS BUILT ])ATE, AUG, lJ, 199£ SHEET,~/3 GRI]), 2437 I I Q Monitor Clean Standard l-tenth;'~ Clean Duf 75' L£NG TDTAL iO, S' DEEP 6,5' DF SEk/E~ /~DCK , 4' m/n, Co yep Locote ]0' dlstont ]3 from all fences ~ Monitor Cleon Out_ v Cleon  Mon/gom - Exist 5round 884 6,5 Fee~ o~ Septic Rock / ]000 GAL SEPTIC TANK 8~ ~DTTDM TESTHDLE TDBBEN SPURKLAND P.E, LDT 9 CDHDE ANCH, AK, 99501 ~2 SF~UTZ A~E SHEET, ~/3 GRID, ~4~7 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Monitoring? , . gate: Township, Range, Section: ~,,~/'~, -~"'/~: ~ "~,j,~ SLOPE SITE'PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ./t).i,~.. 'ii ,~.;~ U ~ '.~.,~>o,~ ~. ~ ~ ~ ~ ~o~ '~ I ~/i~ ~ '.~ERCOLATION RATE 1'2''''~,-' (minutes/inch) PERC HOLE DIAMETER / ,,,-2,~, ~ ~'/7.._ ,,~ ~'~ . ': .... ~ TEST RUN BETWEEN ~ FT AND FT PERFORMED BY: 1 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910358 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:BENJAMIN RICHARD C OWNER ADDRESS:9321 STRUTZ AVE ANCHORAGE, ALASKA 99516 DATE ISSUED:Il/06/91 EXPIRATION DATE:il/06/92 PARCEL ID:01505121 LEGAL DESCRIPTION: COHOE LT 9 LOT SIZE: 9245 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: A SOILS TEST MUST BE PERFORMED AT THE TIME OF CONSTRUCTION A MINIMUM OF 15.5 FEET DEEP TO VERIFY NO BEDROCK AND SUBMITTED 1 2 3 5 I.... -ii 12 I I I I i1 I I I _T_ I 8 V I I I ,iiiii SO 0 50 I00 SEAL& N N~7 ?£,' £LASS A k/ELL SERVES ALL L177S IN SU. BDIVISfgN 150 200 = iOOFT, 250 300 TDBBEN SPURKLAND P,E, ~03 ~ 15TH. AVENUE ANCH, AK, 99501 ~07~ ~7~-8~16 LUT 3 CEHgE S/~ RICHARD 9ENJAMIN 9381 STRUTZ AVENUE SEPTIC SYS'TEM DESIGN , I I I TRENCH 45' LONG ----------% I 10,5' DEEP ~ I TRENCH 30'LBNG iO, Z' DEEP _ ~,w_¢.¢~.__...__~_~_.~_~ %9'5 -~ - - ////// ~ ~S ~ ' I 90, ,99.8 I REPL 4CE EXIS E TANK ~T I ~ITH 1000 GAL TANK ABANDON REMAINING TANK AND CRIB I I SCALE, 1' = 30 FT, TUreEN SPURKLAN~ P,E, LOT 9 CDHDE S/9 203 W 15TH, AVENUE RICHARD 8ENJAMIN ~AT~, DOT. 2~ i99i ANCH, AK, 99501 93~1 STRUTZ A VENUE SHEET, ~/3 6RZ~,2437 Standard Trench; w Clean But 75' LgNd TOTAL i0,5' 9EEP 6,5' DF £EWEI~ I~£CK 4' min, Cover Locofe I0' dlstont From al( Fences Cleon Dut Monitor 4S 13 Monitor Clean Clean DuC I000 9ol Sep tlc tank Mira Pi 240 6,5 Peet aP £eptlc Rock TBBBEN SPURKLAND P.E, 203 W15TH, AVENUE ANCH, AK, 99501 L O T 9 CZ]HOE RICHANJ9 BENJAMIN 938I S ?~UTZ AVE SEPTIC SYSTEM DESIGN DATE, [70T, 2g I991 SHEET, 3/3 GRID, 8437 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SE,~[~) DATE PER FORMEI~% Township, Range, Section: ~.~,~/~., SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water After ~ Monitoring? ~ ~--."? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN .- (minutes/inch) PERC HOLE DIAMETER __ FTANDFT PERFORMED BY: I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY_.ZTHAT 'LHIS TEST WAS PERFORM D~D~ 203 W ]5Ih. Avenue~ Suite 20~ ANCHORAGE, ALASKA 99501 SEPTIC SYSTEM DESIGN LOT ~ COHOE S/D Richard Benjamin No Grounc~ Water ar' Impervic~us L. ayer to 14..5 .Pt,, Use Standard Tre;nch ,.:,c~.~. 1 R a t i n g. From test. Oct. 18, 195'1 20 ~nin/in = .6 gal/m:i.n Required Area per Bedroom,", ~¢..~/. 6 = .~..s,.. sq. ft.. Ground SurYace at Absorption Field 99.5 ~ ....... Tes.~thole Total Depth I,..ess Grc~und Wa'~-er Separation Roc I..'.' Dep th Check ~.)F" Impervious layer :i. n s t a 11 a t i o n 14.':'~., ft 4 4 6.5 'F t .1. 6.5 .F' t. d u r i n g Number a'f Bedroc~ms [...eng'kh o.F 'Fr'ench c, x 2,:."~t),/ (~:. :.,' 6.5) = 6'7.7 f't SYSTEH CONFIGURttTION STANDARD TRENCH TOTAL LENGTH TOTAL HIDTH TOTAL DEPTH ROCK DEPTH COVER SEPTIC TANK 75 FT. 3 FT. lO.§ FT. 6.5 FT. 4 FT. 1000 6AL. ABANDON EXISTING SYSTEM PUMP AND CRUSH EXISTING TANKS PUMP~ CRUSH~ AND BACKFILL EXISTIN6 PIT Sept:ic System Design Lot 9 (:]c:~hor...'.~ S/D pg.1 The installation of this septic system will nc~t prevent from be :i. nstalled on the ad.;jac, ent lots. we 1 1 s There are no developed or natural surface / sub surface courses on t. his or the adjacent lot. s. drainage The proposed septic system will not change tl-~e general slope o~ the area. Ponding and/or concentration of surface runof.F will not result from this installat, ion. Septic System Design Lot 9 Cc~hoe S/D I:.) g- 2 203 WtSTH. AVE. SUITE 206 ~NCHOR~GE~ ALASKA 99501 F:"., E: SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT 9 COHOE S/D SEC 15 T12N RSW 1.0 GENERAL :t.,, 1 Owner is Richard Benjamin~ 9321 Strutz Ave. Alaska 99516. Ph.r.)ne 346-3164. Anchc~rage ~ 1,,2 Engineer is the person or entity hired by the Owner tc) :i. nspect this project. The Engineer must be recognized by t. he Municipality of Anchorage.~ Depart. ment (~¥ Healt. h and Human Services. :1..3 Contractor is the per-sot] or- entity hired by the Owner to :i. nstall th:is prc,)ject. The C~ntractor must be recognized by the Munic:ipality of Anchorage~ Department of Health and I...h.in~an Serv:i. c:es. 1.4 The I)r"awings~ sheets 1 through .3~ shall be part of this spec i .f :i. cat i 1.5 All materials and workmansh:i,p shal], meet t. he require- ments (:)f the Municil~ality of Anchorage~ Department of Health and Human Ser'vices~ the cond:itions of the permit,~ and all app][icable rules and regulations currently in effect. J..6 All e;.'.c:avation depths are advisory~ and are to be verified and may be modified in the field by the Engineer,, ]..7 It is the resp,r..~nsibility o'f the Owner or the Contractor to adhere to the appr'oved design~ to verify that the speci- fied separ'ation distances are met~ and '[hat the required :i. n s p e c: t i ~;.)l] s a r" e p e r 'f: (Ir m ed ,, :1..8 The Contractor or t. he Owner shall report to the neer any observed condition which would put t. he system in violation of State or' Municipal regulations,, Engi- septic 2.0 SEPTIC TANK 2.1 If there is an e;..-:isting septic tank~ it. may be used if it meets the (zapacity requiremer'~t .for the residence,, The t. ank shall be :i. nspected by the Engineer~ and its water" tightness and structural, integrity shall be verified,, 2.2 A new septic tank shall be one fabricated Anchorage Tank and Welding c)r by Greet Tank by either The septic tank shall be a UPC-approved two-compartment tank.~ constructed o~ 12 gauge~ or better~ steel with bitu mastic cc)ating. ]'he tank shall be set ].evel on undisturbed soil.The tank shall be covered with the equivalent o~ .~our · ~eet (:)~ soil. 2.3 The septic tank shall be installed a minimum o.~: ~ive .Feet ~rom the house ~:ounclat.i.c)n arid a minimum ot~ ~ive .Feet ~rom the absorptioc~ area. 2.4 The septic tank shall be a minimum o.~ 100 ~eet ~r'c)m any well serv:i, nga single residence; 100 ~eet ~r¢)m any body o.F wat. er'~ creeks or drainage ditches with ~].owing wa'~er; ].5() ~:eet ~rom Class "C" wells, and 200 .Feet ,Fromm C].ass A or Class B wells. 2.5 All p:ipe connections to the tank' shall be mecharlical watertight calder couplings. Cleanouts sha].l be installed as designa'L;ed and capped with air-tight rain caps. Clean- outs sba;1 extend a minimum o~ :~2 inches abc:~ve ~:i. nal ground e].evati(.".)rl. Prov:isions shall be made ~of landscapirlg and i mpc~rta'l..-.i c~n i.F tc~pso:i. 1. 2.6 L..i~ct s'La'L:i, on shall be as manufactured by Anchorage Tank and Welding 3.0 ABSORPTION FIELD 3.]. Gravel used in the absorption ~ie].d shall be 0.5 to 2.5 inch screened roc:k~ with less than :]!;% passing the No. 200 si eve. · ]'.':.2 Sand, used ~or leveling er ~'or ~iltering, shall have an e~.Fective grain size between N(~. 40 s~.eve and No. 18 sieve,, Uni.F~rmit. y coe.F.l::ic'.i, ent shall be less than 4. Not more than 5% by weight shall pass the No. 200 sieve. · 3.3 4-inch per~:orated pipe shall be AS'T'M F8].0. For pres- sure distribution, pipe shall be Schedule 40 PVC ¢:)r ABS. B.3.4 Solid 4-inch pipe shall be Cast Iron cir' ASTM [)30:]:4. 3.5 Monitor standpipes shall be install, ed as shown,, That section o.F tl"ie pipe penetratin~.~.] the gravel shall be per,c).-- rated,; either by drillinc..] 0.5" holes on 6'--inch centers or by joinirig a section o¥ F810 per~orated pile to a solid section (:.~.F p .i. p e ,, 3,,.6 Geotextile shall be Mira~'i. 14(). 3.7 Insulation shall be extruded direct burial polystyrene,, .[.)ow Chem'i. ca]. Styrofoam HI 40. 3.8 Topsoil shall be a mixture of 40-60% organic matter~ 2()-30% sand and more that 2()% silt. measured by volume. A11 quarlti ties are 3.9 Grass seed shall be Kent, ucky b].uegrass. 4.0 INSTALLATION 4. 1 Locate al 1 underground uti ]. :L t:i. es~ property 1 ines~ -Future dr"iveways~ existing ar proposed water wel].s~ water ways~ sur~ac::e and sub sur'~ace drainage ~aci].ities~ lakes, ponc:ls~ and all other ~aci].ities requir':i, ng separatian d:i.s- i:ances ~r"om the proposed septic system. Noti~:y O~ner or Engineer (:).F any observed possible con-Flic:t. 4,,2 Stake alignment o~ system wi'L:h markers sl"lowirlg the protec:tive d:i. stances ~rom wells arid wa'L:er bodies. 4,,3 Establish an elevat:i, on benchmark,, Th:Ls BM shall be easily :ident:i.~ial:ile~ stable arid permanent.. An arbitr'ar'y elevatic)n o.F IOA cari be assigned, Use tc.~p o.F black .~¢.~unc:la .... T:. i on. 4,,4 Install the i:ank as shown on the drawir'~gs. Record the .i. nlet and c~utlet elevat;i.(:)ns cH: the tank. Tank shall be placed on und:i, stLu~'l:)ed native soil. 4.5 Excavate the absarpticJn .~:i.e].c:l. Bottom c)~ e>,'cavatic.~r'~ shall be level and scsar':L~Cied. ]'.~: sidewalls smear's~ t. hey shall also be scari,~ied. Recc)rcl elew'~tion o'F beginning~ miclclle and end o.~ trench. Record elevation c:~,~ each corner and ceni::er point (:)~ bed,, Cc~nstructic]n equipment shall nat c)per"ate on the ~l(:)or c:~ the exc:avatian. Any material cc]m- pat:ted by the operaticH'~ cJ~ t. he c:cJnstruction equil:)ment, sha].], r"emc:)ved arid rep]. ac:ed with uncc)mpacted mater:i, als. 4.6 F:'lace the rack to the del:)th spec:i~ied,, Do nat cc.)ntami .... nate racl< with native mat. erials or spoils ~r"om the excava- t. ion. Level i:,he rock surface (+- 1") be~c]r"e instal].ing the p e r ~ (::~r at ed p :i. p e. 4..7 Install the distribution pipe. F:~ecord the elevat:i.c)n eac:h .jcJini:. Far' pressur"e syst. em sol. vent we. ld the .jaints. 4..8 []over the distr':Lbutic~n pipe with r"ock~ and excawttion w:ith geotextile beware back.~illing :i.r't?.:.L~].atic)r],~ :i,~c r'equ, ir'ed. c: over t. h e and ,~lacing 4,,9 Record the ~inished ground elevat:i.c;n at the beg midc~].e anti end o~ trench,, Record the ~in:i. sh grc.]Llrtd t. ion at each c::orrter" and a{': the, m'i. dpoint o~: the bed. rlni ng ~ eleva .... 4,,10 Furn:lsh a copy o-F al:L survey ncr,kes to) the Engineer. Spec:L.F:Lcat:Lons ~c,'" septic system instal].atian I,...ot 9 [~c)hoe S/D P ~;I. 3 5.0 INSPECTIONS 5,,1 A minimum of three inspections are r'equ'i, red. The · First inspec'l:.i(~n will be of the open excavatic)n. At this t.:i. me the soil cc)ndit:i, ons will be observed and compared to t. he desigr~ assumptions. Ground water cond:i.t:[ons or' presence c.).~ bedrock will be ver:i.~ied. 'The secor~d inspection will be a,f:ter placement o.f: star~dp:i, pes,; cJistribut, ic, n pipin~]~ t. ank(s) and other nents as specified. gravel ,~ CC] A]p [] .... The 'Lhird inspection will be after" completior'~ of the work. Any deficiencies will be noted and the Contractor no'~:i.f:i, ed. Such de,~:ic::~encies shall be cc}rrected with:i.n ten days. 5.2 Ali. electrical work requires either an MOA electrical inspection or certi ~:ication by an licensed electrician. Submit proof o,.~ inspection or certification t.o the Engineer. 5,,3 Subm:i.t catalog data of all mechanical equipment. 5,,4 Nc:)ti~y Engineer at ].east 24 hour's in advance o~ ning any work., beg i n .... S p e c:: :i. f :i. c a't':. :i. c:)n s 4:(:3 r s ep t i (::: sy s t. e m :i. n st. a 1 1 a t i (::)n L..c)t 9 Cc31'¥:]e S/D p c.~ ,, 4  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT LEGAL DESCRIPTION NO. OF ,~DROOMS I- :~ Manufacturer~~'x Ciq~;;)~ in gallons IF HOMEMADE: Inside length Width Liquid depth i~, ~ Well Dwelling PERMIT NO. DISTANCE TO: Z ~--~ ~ Manufacturer -- Mater---iai Liquid capacity in gallons 1~ Well Foundation Nearest lot line PERMIT NO. ~C~ DISTANCE TO: ~" Z No. of lines Length of each line Total length of lines Trench width Distance between lines ~ Z '" inches ~ Top of tile to finish grade Material beneath tile Total effective absorption area r~ inches Length Width Depth PERMIT NO. nl ,~ I- Type of crib Crib diameter Crib depth Total effective absorption area '" Well Building foundation Nearest lot line ~ DISTANCE TO: .~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARK~ APPRO~ DATE LEGAL 72-013 .3/78) 'NICIPALITY OF ANCHORAGE Department G- Health and Environmental :otection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * -~ \C~-3~'- W~b~s:k'~m~l~/OR ON-SITE SEWER PERMIT Applicant: ~!,~L C ~'~ )~ Mailing Address: ~ Location: ~ ~ ~'~7_ fl~ Phone Number: ~1~ Legal Description: ~ ~ C~oe. ~ Lot Size: Type of Soil Absorption System Is: ~'F~2 Trench: Drainfield: Seepage B~d: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: q]EPTR~ U PT~ ..................... :' ~ F~FA~E ~DI~ t~e botto~ o~ t~e exc~tLo~(L~ ~eet), ~e~e 1s ~o set t~e botto~ o~ t~e exc~atLo~(L~ "" REGUIRED SEPT[C(HOLDZNG) TANK SIZE = /~-~ GALLONS installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co,unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * * I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if to include more that 3 bedrooms. ~e residenc/~is remodeled Sign e'd :~~~ ~ /~plicant SWP/024 (1/81) GAAB-HD-I Gl~r ~TER ANCHORAGE .AREA BOROtl'~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY / ut . PHONE ADDRESS ~-~ ~- MATERIAL '~/'st ~ GALLONS. INSIDE LENGTH NUMBER GE /~.,, CO~,~PARTMENTS. / /' ~' ' ~'~Z~' ~ ~"f- 7G ) LIQUID ~, INSIDE WIDTH ,-/ DEPTH__ SEEPAGE SYSTEM: SEEPAGE PIT: NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ ~fSQ. FT. TILE DRAIN FIELD: / / , OF LINES ..... ? , SQ. FT. ABSORPTION AREA DEPTH.. TOP OF TILE TO FINISH GRADE LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TypL/~/L ~/~""'"~ . DEPTH ~ DISTANCE FROM WATER NEAREST SEPTIC SEEPAGE LOT LINE *~'~ SEWER LINE ~'-/~ , TANK ~' SYSTEM CESSPOOL SOURCES ~J~'~::( ~ DIAGRAM OF SYSTEM DISTANCES: ,, ? DATE APPROVED , HI~ALTH~ AUTHORI ¢~ ., GAAB-HD-2 GREATEI 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 9ROUGH c~ No. Z~ ,'.-----~9-'-z511 * DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~£~' PERCOLATION TEST RESULTS BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ~"~' '"~~ ,PERMIT TO INSTALL A ~ ~ 'r AS DESCRIBED B SIZE OF UNIT TO BE SERVED ~ ~//~ · SEPTIC TANK SIZE TYPE ~,~--~/v~e'."J~'~EEPAGE AREA TYPE C~.~/'~c~g~f~-' DIAGRAM OF SYSTEM I certify that I am familiar with the req above described system is in accordance with said code. DATE Anchorage Area Borough Ordnance No. 28-68 and that the Feet Was Ground Water Encountered?__~o.~. Reading Time C0,5A MUMUPAUTY OF A HCHORAGE G�o� �J' Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-051-21 1. GENERAL INFORMATION Complete legal description Cohoe Sub, Lot 9 Location (site address) 9321 Strutz Ave Current property owner(s) Mailing address Real estate agent Expiration Date: Jw. f 3 , 2 o a3 Richard Benjamin Day phone (907) 240-9230 9321 Strutz Ave, Anchorage, AK 99507 2. TYPE OF DWELLING: ❑® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well E Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Z50 Date of Payment Receipt Number _ COSA # 050-9 1007 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 1/12/22 TH �9 til 6. DSD SIGNATURE ' ' ' ......... System #1 Approved for bedrooms Benjarr chiller System #2 Approved for « bedrooms �����sr , CE 12592���� 1 /12/22 � Disapproved �lliF�PROFESS1oNa��+ Conditional approval for bedrooms, with the following stipulations: By Original Certificate Date: df3/20,;?2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Cohoe Sub, Lot 9 015-051-21 Community Well PWSID 212924 <1 Advantex/Plastic N/A ■ Installed on 9/8/21 Deep Trench 9/10/21 ■ 4 9.0 4.0 ■ ■ N/A COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 1/12/22 N/A N/A ✔ N/A N/A N/A N/A N/A N/A N/A N/A ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 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 I Lj Day of s710A,6t. of 20 -a-) , by and between ajerein the "OWNER," and the Municipalityof 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 Wastevvaiter Treatment Systems. The Municipality grants,permission to the - - —Owner to utilize and operate an Advanced Wastewater. -Treatment System (AWWTS), described as �V 'ti"' x located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Q:_ Throughout 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 kgC 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 repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (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) Pagel of 3 p Owner acknowledges that the Municipality may request records of maintenance and repairs from the mallufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 7 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 AtVWTS 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. r / 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 f_ncv 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. Non-miliver. The failure of the Municipality at any time to enforce a provision of this L�c 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 ec ' L the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. 3urisdietion: 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 SG l jurisdictiotn,shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 ;ON)Vitii)EIt t '-- By., {sigiiature) Date:, 7�ayen tl'C 1WCje (lariat iune) Ts� STATE OF ALASKA }' )ss. TlJIRD,JUDICLAL DISTRICT The-fQr>rgoiit irtst�ument was acknowledged before rile this 'day of ;�niv Aiaio� 20? Z, by �'' --r1 g i 0, k 1 a Nib ItWELL Pt113 FOR A.LA It1 My Ctimtnissiniy ex))ires: t�') 2 U` GEOFFREY D. ROC" Notary Public State of Ates Mar 23, 2024 MY Commission Exp MUNICIPALITY �y. �� (signature) Ee,�1'�C�ro l (print name) State of Alaska ) )ss THIRD JUDICIAL DISTRICT ) Date: f ► 3 X022 Title: The forgoing instrument was acknowledge before me this 13th day of January, 2022 by Rtja-W."t LNW N Uoy- ,x=}t Notary Public For Alaska EARRIANE MAE L, LACAR aryPubilc e of Alaska Expires Jul 19,2023 My commission expires; ---- j�— 2023 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~--~;~ '~1 TYPE OF WATER SUPPLY: NOTE: Individual well Community well ~/' 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: 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 (Rev. 1/91) Front MOA ~21 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. Name of Firm Address Engineer's signature Date DHHS SIGNATURE /~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG g.p.m. AT INSPECTION NIUNIC!PA!.ITY ~F ANCHOi,~r~E ENVIRONMENTAL SERVICES glVI$1ON ";,:.',Y 1 ] 1~9,3 EIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots t~,/,,~~/ ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 67 .~ Tank size j ~-C~.'~'? Compartments Cleanouts (Y/N) 7/ Foundation cleanout (Y/N) 7' Depression (Y/N) High water alarm (Y/N) i~J/~ Alarm tested (Y/N) Date of pumping J~//'~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot --/'~ To property line ~7.~> Sudace water/drainage On adjacent lots Absorption field Foundation 7 Water main/service line ~'5 4) ',~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION 1~1 [~) ~N} ~-- Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '~/~/~ '~--- Length '7 ~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) Width ~ Gravel thickness '~ ~'~-~' Cleanout present (Y/N) - ~/~,~. Results (pass/fail) System type '~-~ Total depth Depression over field (Y/N) for "~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J~J//'~.- To building foundation ~.~ On adjacent lots ~> ,.:~? Cutbank Surface water l'k-j Curtain drain ~k,[ © [,~ ¢_.___ On adjacent lots /'~//~- Property line To existing or abandoned system on lot N~:~ ~/~ P.~. Water main/service line iD Driveway, parking/vehicle storage area ~' ~:~- 0 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature . ,--/... Engineer's Name ' ~'~ LJ HAA Fee $ / 7~ Date of Payment Receipt Number.~ 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number ' DATE RECEIVED INSPECTION APPOINTMENTS £ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTOR~-~ MUNICIPALITY OF ANCHOEAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~J~I~NMENTAL FJ~OTECTiON 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ~EC ~. 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~L~I~=~(~I~,~I~S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER MAI LING ADDR ESS PROPERTY RESID~=NT (If different from above) PHONE 3. LENDI~ INSTITUTION I PHONE MAILING'ADDRESS 4. REAL"TOR/AGENT '-- .... MAI LIN G ADDR ESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY PUBLIC UTILITY NUMBER OF~SEDROOMS [] One [] Four [] Other [] Two [] Five Three [] Six * ATTACH WELL LOG, A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(Rev. 6/79) ~ / ~..~'~ 0 ~/ ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] TWO NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SlX 2. WATER SUPPLy [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE F-IPUBLIC UTILITY Connection Verified []Septic Ta~D.nk or []Holding Tank Size: ~-~~ If Tank is homemade give dimensions: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER Sewer Line [ Nearest Lot Line Septic/Holding Tank IAbsorption Area 5. COMMENTS DATE [~].-~CONDITIONAL APPROVAL (letter m~ / [] DISAPPROVED V~ ~ BEDRO()MS ompany certificate) 72-010 (Rev. 6/79) ALASKA UIRO m nTAL CONTROL $ RUIC $, I C. ~n§inee~inq $ I~,ui~'o,mental Studies ~UN~C~PALITY OF ANCHORAGE D~PT. OF ~'5/~'~; ~ ~ ENVIRONiV¢~ i'<~ ~' x:., , ' - '~CTION RECEIVED [)EL, EME, E:I'~ ,'3 1980 ,.JA[.,I., [; U '¥1' I.. E: ,.,,...,. !3 T R U l Z A g AN Ci'.IO ~.,,A (,,I. AK 99507 sIEgLER .-. JACK [;LJT'TLE S~J E:[) :I: V :][ S:I:[]N-. C 0 I..1[) E:I_OCK-O LOT-.9 'THE TYPE OF:' ABE;ORF:'T:[ON SYSTEM IS A PIT N:ZTFI AN AREA OF 4:32 SQF:'T. THE SYSTEM ]:E; CAPABLE OF' ACCEPT:ZNG 8568 GALLONS OF NATER PER DAY. THE SO:I:I...S RATING OF:' THE: SYS'I'EH AT CONE;TI~UCT:[ON NAS 225 AND NON E:A~;ED UF'ON THE TESI' DATA 'filE: SYSI'EH ZS ACCEPTABLE FOR 3 13 E D IR 0 (:) ~ H 0 ~ E, 'I'HE SEF:'T];C TANK NAS F'U~PE:I) ON ~2/3/80 h ~ROFES5~~ 1220 UJesl 25th Aucnu¢ · An&ora(F, Al(~sk(] 99503 · (907) 276-1361 MUNICIPALITY OF ANCHORAGE ' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION (/k~,~ i ~ 825 L Street - Anchorage, Alaska 99501 ~,~,~ ~_.il~//,/ ENVIRONMENTAL ENGINEERING DIVISION * ~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ,1. PROPERTY OWNER PHONE Hass MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE '2. BUYER PHONE Bodine Contact phone 265-2876 MAI LING ADDR ESS 9321 Struts Road 3. LENDING INSTITUTION I PHONE National Bank of AnchorageI 265-2883 MAILING ADDRESS Pouch 7-025 99510 % Ruth 4. REALTOR/AGENT I PHONE' I MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 9 Cohoe Subdivision STREET LOCATION 9321 Struts Road ~/~ ~ ce c~ &~4- ~p~ ~3//L~x3~3 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY [] Other * ATTACH WELL LOG. A wel log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) **If individual/on-site, give installation data 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. ~2-010(3/78) TIME DATE INSPECTOR THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic '[a_nk or i--IHolding Tank Size: '7~'(3_ If Tank is homemade give dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER INSTALLER SOl LS RATING TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line IMANU FACTI~I,R ER MATERIAL Septic/Holding Tank IAbsorption Area ISewer Line I Nearest Lot Line 5. COMMENTS [] [i~ISAPPROVED APPROVED FOR BEDROOMS CONDITIONAL APPROVAL [letter must accompany certificate) DATE LEGAL DESCRIPTION IBY (Title) 72-010 (Rev. 3/78) July I3, 1~78 Anchorage, Alaska 99502 Before this d~partm%~nt will approve the request for sewor and. water approval, ~ev~rat items will ne~d Add an additional 500 gallon s~ptic tank in conjuction with the 75~ gallon tank already in place. Pump th~ septic tank for maintenance purposes. Supply this office with receipt of the pumping. or Jo~m Lambe, ~76-4113. In the :event the test shows the syste~ is not a~equate for a three(3) bedroom dwelling an upgrade would be required o Prior to any constructi~n, a permit must be issued by this de~rtment. If there are any quemtiens, please oontact this office at 264-47~0. Sincerely, Robert C. Pratt, Sanitarian RCP/lJh National BAnk of Alaska % Ruth Pouch 7-025 99510 MUNICIPALITY OF ANCHORAG~ Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 264-4720 ~/R~equest for Approval of ]Individual Sewer and Water Facilities PropertY Owner: Mailing Address: Name of Buyer: Phone: Mailing Address: Lending Institution Mailing Address: ~-~ Phone: ~ ~- ~;?g ~0~ A-,~ ~ Phone: Realtor/Agent: Mailing Address: Phone: Legal Description: Street Location: Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well (/) If Individual Well, well depth If Community System, name of system Sewage Disposal System: *~n-site System If On-site System, date of installation: Public/Community System ( ) Public System ( ) *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