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Home My WebLink AboutLAMB LT 3 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: OSP221469 Work Type: Septic Upgrade Tax Code Number: 01715116000 Site Legal Address: LAMB LT 3 G:2939 Site Mailing Address: 7325 OUR OWN LN, Anchorage Owner: SHERBAHN BENJAMIN F & IDA Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: �i»enC CNo� DeI)artine nt 12/6/2022 12/6/2023 43600 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: /t�t,� t , ' �so►� Issued By: (/(/ Date: Date: /ZA ?_ MUNICIPALITY OF ANCHORAGE Development Services Department p��;....� Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-151-16 Property owner(s) SHERBAHN Mailing address 7325 OUR OWN LANE, ANCH, AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) LAMB LT 3 Legal description (Township, Range & Section) Lot Size 43600 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field E] Initial ❑ Single Family (SF) 0 Septic Tank El Upgrade Q (w/wo ADU) Holding Tank El Renewal Renewal ❑ (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 57q Sr �; G7 Waiver Fees: _ Date of Payment: /1l11e [ 2:2 Yhe2Date of Payment: Receipt Number: of (05-4s07clReceipt Number: Permit No. 05PA;t1q&9 Aa--" Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Nov. 15, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic permit Legal: LAMB LT 3 To whom it may concern: This is a request for a septic permit on the above referenced lot the existing system has failed. A single test was excavated and found poorly graded sand SP for the entire depth. Water was observed at 11 feet then measured at 10 feet after the 7-day monitoring period. The perc was measured at 4 minutes per inch. A new STEP tank has been designed to allow the new field to be installed on the up-hill side of the driveway where the soils appear to be better. This new proposed septic design will not impact any of the neighbors or encroach on any wells, septic or open water issues. The old tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221469, Deb Wockenfuss, 12/06/22 SEPTIC FIELD SECTION DESIGN CRITERIA: 4.5' EFFECTIVE 3 BDRM X 150 = 450 GPD SOILS = 450/1.2 =375 SQ FT REQ'D 375/2(4.5) = 42', USE 42 2.0' WIDE 45' LONG (1) TRENCH 5.5' DEEP -12' (TH#1) -0.5' SM OR 1.5'2.0' -5.5' -1.0 MOUND OVER FILTER FABRIC & SEWER ROCK 3,3(: GRADE 1"=200' PROPERTY LINE PROPOSED DRAINAGE FIELD 4.5'EXISTING WELL 100' RADIUS -OUR OWN LANE--LAMB DRIVE--KELLY RANCH ROAD- EXISTING HOUSE SCALE: DJRDRAWN: DATE: LAMB, LOT 3 Anchorage, Alaska BENJAMIN & IDA SHERBAHN 11/6/2022 -OLD RABBIT CREEK R O A D - WATER AT 10' OCT 2022 INSULATION +2/(6# Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221469, Deb Wockenfuss, 12/06/22 1"=50' PROPERTY LINE EXISTING HOUSE EXISTING WELL 100' RADIUS WELL LAMB S/D LOT 3 KIMBERLY MANOR #2BLOCK 3, LOT 1SCALE: DJRDRAWN: DATE: LAMB, LOT 3 Anchorage, Alaska BENJAMIN & IDA SHERBAHN 11/6/2022 -OUR OWN LANE--KELLY RANCH ROAD-DRIVEWAY EXISTING SHED EXISTING GARAGE NEW 1250 GALLON PLASTIC STEP TANK LAMB S/D LOT 2 RABBIT CREEK #2 BLOCK 1, LOT 1 RABBIT CREEK #2 BLOCK 1, LOT 2PALATERRAADDN 2, LOT 5RABBIT CREEK MTMT DCO TH#1 SEPTIC 4" OF INSULATION X 4' WIDE TYP.SLOPE > 30%SLOPE < 10%SLOPE < 10%TOE OF THE STEEP SLOPE, FLATTENS OUT TO <10% 4' CONTOURS TYP. ADDITIONAL FILL REQUIRED OVER THE FIELD, 3:1 SLOPE MIN. OLD TRENCH Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221469, Deb Wockenfuss, 12/06/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221469, Deb Wockenfuss, 12/06/22 LOT 2 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: LAMB SUBDIVISION LOT 3 PLAT 70-216 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES; It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE; E—MAIL AUG 7, 2022 1 "=50' schuller0ok.net 22-088 DRAWN BY. JCHECKED BY GRID NUMBER: BOOK AGE: JAS I SW2939 1 220275 LOT 1 !NNN, Sul? V A OF 4Z V. '-,-I i'v j\0 10of ;D , 411 49TH 'k ......... ........... . ....... VA ?j PA ....... .................... .... . ..... HN L. SCHULLER: .0 T LS -10408 fle Ito,, OT. 4"Jio 1831 Talkeetna Street 6 A1W Anchorage, Alaska 99508 `� AW ofess.ono\ (907) 227-1455 office (907) 274-4992 fax . ~ 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 NAME [PHONE [] UPGRADE LEGAL DESCRIPTION NO. OF BEDROOMS ~ DISTANOETO: ]Well I(¢ S~ Absorption area ~- Dwelling ~,~ I PERMITNO~) ?e.~_~ h- Manufacturer Material~ ,e ~ ( N°' °'Dmpartments ~ Liq. cap~c~ q re.et ~° ns ,FH O M EM~DE: Inside I~n g'~. Width Liquid de pt h -- -- Well ~welling PERMIT N0. ~ DISTANCE TO: a Well Foundation Nearest lot line PERMIT NO..~ ~O ~_~ ~ No. of lin~;o ~ Length of each~ Total length of line~) Trench widtl~ ~ inches Distance/)/be~een~ lines ~ ~ ~ Top of tile to finish grade I Material beneath tile ~ .~ ~ ~s Total erfactive ~a~)°rpti°n~")area Depth . PERMIT NO. Length Width ~--~ ~ Typ~[ Crib diamete~ .... Crib depth " ~ISTANCE TO~ F~ Buildin. fou~' Nearest lot line Building found~ti~ Sewer line ~ DISTANCE TO: ~ ~O ~ ~ Septic tank ~()~- Absorption area(s) OTHER ........ ~IPE MATERIALS SOIL TEST RATING INSTALLER ~ /n REMARKSk~ 7~ .p ,o~ APPROVED fi) DATE LEGAL 72-013 ' 3/78) ill' ~'~] ~: FIT i[ t--' [iil (i!i I:::1 [ I ~ T ,' "1 .... . , · . f .:. Cfi:: :!:: ")][ J.. F::ll]iirf~i!;Ctl:;i:lii!:T" r'll, J ;Ei;"r':i]i;'Fl:ii]'"i ])i fi; "]'I.IIZ I...t!i:J'.,l(i!iTH I:i:, ]: I'"ll:!!:i'.,!:B :t: CIIq ): ;iii: 'T'Hlil J .!Zl'.,l(iii'l"l.I TI..IIZ [i:,I.!!iF"I'I'I (ilft::' I::! 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'.i!i;l:::'[!iX::: :1: F:' I C:!'::IT ]: Ol",l:!ii; I:::t1",1[) COF,l:!ii;] Fi:I..IC:T :[ ON [::' :[ I:::ll:~i!:~:l:::ll'"l::i!; I':l',,,'FI]:l..l:::lti!:l..[i: 'T'O ]:l",f!ii;I..ff;i:E l::'~:l:)f:::'[XI;;: ";[HUM NLIMBER OF E:EDIq'r'-i"I'S¢ = ;~{ SOIL. F:FtTi,:",h~ (C;l'] !--T,.'"E:F-:.',= :F7 RE~]g. JI,gtEB, SIZE OF THE SOIl_ ' E::Z P T Fi :== LEE ~".4 C;.~ -'F H '-== TIdE LENGTH DIMENSION IS THE LE/.,!GTI4 (iH FEET) OF THE ]'RENCH OR DRRINFIEL. D. THE DEP.TH OF R TREHCH OF.: PIT IS:, THE D!S'I-RNCE E',ETNEEH THE SURFRCE OF THE GROUiND RND THE BOTTOM OF THE E::<CR'v'RTION (IH FEET.'.,. THERE IS NO ~;ET 14ID. TH F()R TRENCHES. THE GRFtYEL DEPTH IS THE MINIMUM f_'.,EF'TH OF GF.'R'v'EL E',ETHEEN THE OLITFFILL PIPE lAND THE BOTTOM OF THE E><CRYRTIOi',I (IH FEET). 7;RMIT F!F'PLIR'n ,n- iL Ibff:OE:M THIS B, EF'ARTMENT DI_IRING THE _.,x,,. HRS THE RESPF'NSIP, II_I--"r' ISTRLL, RT~OH ZNSF'ECTZONS OF RNY 14ELLS FE,SRRENT TO THIS PROF'ERTY FtHD THE .IMBER OF RESIDENCEL-', THR]' THE iqELL HILL SERS"E. :~CKFILLIblG OF RNY SYSTEM HITHOLIT FIHAL INSPECTION Ri'-~[) RF'F'RL')'v'FIL B't' THIS ;!{F'FIRTMEN'F !.dILL BE SUBJECT -FO F'RF~SECU'FIOi'-,!. iNIMLII'I D~STRNE:E E:ETF.!EEN Fl HELL RN[:, ANY OI'.,!-L-_$ITE SEHFIGE [)ISPCISRL. SYSTEM I_g ;'~O FEET FOR R PRIYRTE !dELL~ OR 58 TO 200 FEET FROM FI F'UBLIC HELL PEF'E'NDIi'.IG LIF'ON TIdE 'I"YPE OF PUBLIC HELL, iSI_L LOGS RRE REQUIRED RI'ID I','lLIS'r E',E F.:E'rLIRNED TO TIdE DEF'flR'I-I'IENT HI]'HIN 30 DAYS F THE I,,IELL COi'IPLETION. THER REQUIREi'flEHTS hlR'.r' APPLY. SF'ECIFICATIOi'-,IS Al't[) i]:ON'.B'FRUCTION DIRGRRMS ARE 'v'FIILIRBLE TO INSURE PROF'ER INSTFILLFIT~FIN. CERTIF"r' THFtT ' )1 .RM FF~MILIi::ff~: !.4I'1:'I~ THE REQUIRE. MENTS FDR ON-SITE SEHEF::S RND WELLS aS SET )R'I'H E:M THE I%UNICIF'I3LITY OF FINCHOE:FtGE. ' I ~,,lIt_L INSTI::~L.L THE ..,'~..,TEM Il'4 RCE:ORDRNCE I,.!ITH THE · I LINDERSTRN[) THI-qT THE ON-gITE _'qE!-,.IE~: SYSTEf'I HFIY REQUIRE ENLI-hRGEMEHT IF THE --'qIPEi",ICE IS REMODELE,(-) ]'El Z.HCL. UDE MOF,'E THRN ~ t3EDROOI'IS· ...... / ' //' /'/ / ? i-},~/ I-gP P L I L;i<i-l':~ T ' ,,.~) / . :!-'.:~.:UEp _.:. ': 3' z .... x../,'__._:}/__., ............... - ':'" .......... ?- .............. ;/"t ',--/?, ' .~, ~, ,,,. ,'~ ,' ,~_-,. "-; cr,x' ._,cc.,,-.4..4 L' ¥ /x~%./,.._/<; ,?~,'ux,-x.W. '--¢ 4' - . ,.-~,~b-3 f ~ ,.~ v,....-.-~_ - · /?- u /'7 ' PERFORMED FOR: LEGAL DESCRIPTION: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221' SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN · FT AND , FT PERFORMED BY: ~HA.Y ~" /A'~:Lc''')'~ 72-008 (7/76) GfZ. : E:O [,~:[::,I:IN E:t-.~: "'IHUH..., HLII,1BEF: ElF E:ED~:LqC~H'.5 = ~.~, SOIL. F:Ft'F ! NG :., 'r ::, ] EH · 'E RE6.!I_III~:FD SIZE OF THE SOIL FIDSOF4F'TION "-"( .... ' THE LENI3TH DIHENSION I:5 'l'ttE LEHGTH ,::iN FEET> OF TtflE TREHCH Cfi;: D~:FtINFIEL[:'. THE DEP,i'tt OF Fi TR'EHCH GR PIT IS THE [.'IIST~NCE E',ETNEEH THE SI_IRFFtCE OF THE GROLIN[:, BND ]'HE BOTTON OF THE EXCI~',,,'RTION (IH FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRBVEL DEPTH IS THE HINIP1LIH DEPTH OF GF:iB'v'EL BETI4EEN THE OUTFFILL PIPE FIHD THE BOTTI]H OF THE EXCRVFtTION <IN FEET>. :: E+-_ GQ-. IJ :[ F-7: DZ- E:, :::F::PIIT FtF'PLICP, HT FIBS THE F:ESF'PHSIBIL!-"T' TO INF13~ff'l THIS [.',EF'FtF:TP1EHT E)UF:INI.-i THE ~?,TRLLFtTIOH INSFEL. TILN_ I]F F1NY' HELL. S BDJf~E:EHT TO TttIC; PF:OF'EF.:TY FiND THE Ir'IBER OF RESIDENCES THBT I'HE HELL HILL _,E.F. vE. T l-.J bTJ ,C 2 ) I I'-J 5 F' F:__ L--:.- -F' /_ I.:J ~'-4 :--__~; F:I FE: ~: -F~-: E L-~-. L! I [04 [---~ :IC:KF]LLIHG LIF RN'Y S't'STEr'I H]THOLIT F~NBL INSF'EC:TION hND RF'F'RO',,,'FtL Bk' THIS EF'FIRTHEN'F HILL BE '.SUDJECT 'FO F'F:OSECU'F]ON. iHIMLIH DISTRHC:E E:E'FHEEN B NELL RNE:, Rt.4~' ON-SITE SEHI~LSE FEET FO[?. R F'RI',,,'FtTE HELL.; OR TO ~£1e FEET F'ROH FI F'IJBL. IC: 14ELL .F.,EF'ENDING LIF'I3N THE 'Fh-'PE OF PL,IE~L IO HELL ~ELL LOGS FIRE REC!UIRED FtND HI_I?F E',E RETURNED TO THE DEF'BRTI'IENT HITHIN THE HELL COP1PLETICIN. FTI.-IER REF4LIREHENTS P1F/'¢ RPPLY. SP[:'.CIFICFITIC$,!~ I':iN[> -]N5$TR_ICTION ',,,'I:~ILFtBLE TO IN':;URE'PROF'ER INSTBLLFITION. C:ERT I F'¢ THRT -:. : ~ .RH Ft-RPIILIR[4: WI~H THE F.:EQI_IIREME:NTS FOR OH--.g_,ITE SEHER.-g RND iqELL_S RS SET OR'FH E',sd I'HE HUNICIPRLI'FY OF BNL-:HO~:F4GE. : I HILL-INSTRL.L THE SYE;TEP1 IH RCCFde. F.:,FINCE HITH THE CODES. : I UNDERE, TRND THRT THE Of4-'SI'FE SEHER: SY'STEI'I HFf'," RF'C,!UIRE ENLRRGEHENT IF THE F':-:IDEIiC£ IS ~'.EHODELE,[~ TO I.HC. LLIDE HORE THFIH ~ RPPL I c'¢.~n T . ,,, :~r ~, s, /'-' c;,/,~/, o. ...... :--t- ............... /'?-- .............. ' .... ' ........... ......... ........ ":'"' SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF ~50 WacJ;o dRILLED AT THE RATE Of //~0°00 PER FOOT. /~. ~ #~ock. 34-4-8981 PROPERTY OWNER LOCATION OF WELL SITE DRILLER WELL LOG: 0 ..... 26 ' 26 .... Sdd~r Caved... 20% c.d~5 ~dvt¢~ 1.5% ~an. d4]. raz~e~td, ad., ¢,,aztze. L tag,Cd~. 35% ~ h,:r, de,zo 135--14_7' 8,tX,~j. ,~ard~ o~evt. ~:z.tezJ. o.Z. 20%o cZ~9. 147--150' flood cd. ex~ za,~e,z he. awt~ mate.,vt, ad. t~wd~_.Zr~9 a /~o~Ze 9§?lll, ,zecove,W. ,~koud/2 co,~¢ &zck. ,6o tagadvOz 50 Fee't o~ ,w.,J~ce. 3/4 t.~o,~e Suds. Cc~g o~ 9alLtgt~: ~19.00 X 150 fee.~t: $2550,00 Cost. o~ ~ell.$e. wt: ~21o00 LAbOr AND MATERIA(L%OR COM~ETIONkD~f~I~NG~5-(O0d'~ WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF f/2871o00 THANK YOU VERY MUCH, 1979 DATE BERNIE~SUS OF RAMPART DRII~ING WORKS SERVICE CHARGEOF 1~a% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. : ' ~.:~-i'-"-, ,:.,?_.... .,,...~'.%..:~... ,,~: .,.MUNICiPALTY.oF.^NCHOR^GE ...-. _ ~ ....... ~,-:~;, . ,:':'.":: {-~'¢-";".,': %~ .': .' 'DiviSi0n. 6f'Envb6nmentalSe~[bes'.,'-" . ~ ' ,-'- ".', >,L,": ' , .... ,. : ' - P.O. Box'196650::AncbOrage;'A~aska' 99519-6650 CERTIFICATE O~ HEALTM AUTHORITY "" "' ' ' :'::' '~ :;" ~PPROVAE' FOR'i"S ING CE ~AMILg DWELLING :.' Parcel i.D','~-"O~ ~ ~ ~[~"~"?;'¢'~':~:':'"' '*'r' :~:.]~:,~,~;?~;;~?.::,:'-: HAA'~ ~~ 5 S k ,'' : :"'- ' , ..... ""'-. '.',',. ;';'-" '"' '-'-,,"~ "'"' '".:'."¢:'~.' ',k.-" ' ~" ....... · - -" · :,';'~: ..... 4 ~~' '" '* ......... ~ ...... ......... ' ........... ~.-, ""' " ....... ' ....., ' '~'-.-" ..... - ..:..~.~,....~ INFORMATION..-,~::,.:.:., Complete ega descnpbon: z.~ ~ ~ ~. · .... . ",' , .'~! - ~ : ,_ ''~'''' -- ' .......... : . ~,~/: · : :: Cocabon (sitoaddro~s ordiroct 'Day phone .- ........ Jhone confir'rna~ion from State ADEC ~-"'", ":'": ',:, ..: ' -': : ~';:'~ :NOTE: ;': If CommUnity wa~ ~a'l ~ide W~ ~ >nfirmation frOm State gDEC >; : ::.::'-;: :~: ':~."~'::"~:;:~::': :a~esting ,'ti e loi~ ~tem, ~' ~'-~ ';",: : :'",' ::',: . ::::,;. 72425 (R~. 1/91 Fro~t MOA~21 · ;,' '~ ; ' .: : .... .... ============================ ,- : ,,.; STATEME~?,~ :INSpECT!ON BY,.: ENGINEER,~, .,-~?~;~:~0-~.--~=: ~ :.~:.':,,~,¢.':.t~' ".-~ .~ <:5:?:~ ~ _" As ceAified by my seal affixed hereto and as of the validation date shewnr be ow; I veri~ that my investigation of this Health Authority Approval application showsthat the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the ~umber of bedrooms and ~pe of structure indicated herein. I fu~herveri~ that based on th e information obtained from - the Municipali~ of Anc~0~age files and from my investigation and inspection, the on-site water supply and/or wast~water disposal system is n corn pliance With all Municipal. and State codes, ordinances, and reg'ulations in effect on the date of this inspection.. :::; ; ¢':):'~:::,: r''1 ~ - ~. ~ 1' '1 :' ' : *''' " '" :'-Nam;";; F;r'~'"'-~; O:::'<[~ '~'~ /~ ..... ~' ; ' '" Phone ':~'}-~ 7.~': ~;:,".~'-:~::;'~ ''~'~'?: '.' · ': '-' ,; 3 ·' · ' .... ..'":.,5.: :' 5 ,;'"'. ..... . "'...V. ~..: ...... . .; ¢,;',? ,.: ,. ..'.::,-,'...:.--_'_ . ..,..,' ,:. - .' ,. ' , · ,. L.'/'..'.*.-.,'... .... ',.~ .,::.:-,L.:'/L...,...~... ..... .. - -. : · ,,....... .. _ .. <:.. B¢:;?'!~ X~ ~ ' '"~":',~ ~~"":"~" :""~ "-~:""~'~"'eate 2 t' :~.,[},~/~:,,;ht ~ll'llL'li ::~,;: ;: ,' The,rMoni:~i~ali~ of: Anchora%:D~0~ent.of H~alt~ and H~.S~i'd~S-,(DHHs~:i%U~s~:H~aith::,AUth0ri~,r,~:::::~,?:~ ~ ' 'ApPrOVal Ce~ifiCateS based on¥' u~°n'the rePresentat ohS' g V~n n Paragraph 5~b%~' b~ ~n'" ndePendeht ~:";;~' · ~ '" :' :Profe~i°nal engin~r registered in the'state 0f'Al~sk~; The DHHS does thirds a cO~S~ ~o pUr' ~h~em o'f homes-:'.~ ~'}.,~.~'~; :~ .:~ and their lending i9,stit~tions in orde~to ~tis~ CO'din f~e~ai and state requirements Emp °Y~s of DHHS do not ~r 5 : ~O'~ct" i~s~'cti~ '6~ anaiY~~ d&~atbef°re:a Ce~ifiCate i~ iSS'ue~.'The Mun c pa ~ of Anch0~age s not; :~: -~'?.':res~0nsible for err°~'~r omi~i°ns in the` p~e~i~ ~i'h~s W°r~'.': ;:: ~: ~ .; ::.":';~':~7 :~: ~;'~ :::': :::: :;. : ':: -?.~ Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type ,~',~,~-¢4 ~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~' Date completed J'~,~ ~' ,~ / <~Z'¢ Driller ,~,~,-~','~,,~'~- ~,~,'~.~/,~ Total depth / ¢-~/¢/ Sanitary seal (Y/N) Y Cased to / ~"¢,~:,,'. Casing height /,~- Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION //~'~. ~ /~'¢.¢'" Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: .g.p.m. g.p.m. Septic/holding tank on lot //,~ -~,,~--,.z. Absorption field on lot _ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~, ~,~ ~ /~,~- Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ,,'c/~ c/ / ¢ ~'/~ Tank size Cleanouts (Y/N) /v' Foundation cleanout (Y/N) High water alarm (Y/N) ~ Date of pumping ~-/~'-' ~ .,~ ~/ '" ~ ~F- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot //~ ~'",~ To property line ,-'d2 ,,:/_~-,.z. Sudace water/drainage /~',~',~ ~.'~ Compartments Depression (Y/N) Alarm tested (Y/N) Pumper /,¢,~¢-'~ ~ .~ On adjacent lots /'~'~ %'~/. Foundation ?-'¢-' '~-'P. Absorption field .~,---,,~--~z Water main/service line 72-026 (3/g3)' Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTA. I~R~M LIFT STATION TO: On adjacent lots Manhole/Access (Y/N) "Pump Sudace water D. ABSORPTION FIELD DATA Date installed .'/../',~ ~ Length /--/~ .,~x' Width Total absorption area Soil rating (GPD/FF) /- J~"/· Gravel thickness System type ~/, Total depth Depression over field (Y/N) /'-'/ ,¢/,¢,,¢ .-~"/~ Cleanout present (Y/N) Y Date of adequacy test ,,¢?o,~'./-~., /¢¢..¢'- Results (pass/fail) Water level in absorption field before test / P','~. Peroxide treatment (past 12 months) (Y/N) .~?~-~' for --¢ Bedrooms After test .~ ~//'~ /'~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /.~,~ ,~-~z. On adjacent lots /~¢) '/,z--.,z Property line To building foundation ? ?>r/. To existing or abandoned system on lot On adjacent lots /~ z~ ~-.z~/ Cutbank .zJ/~ Water main/service line Surface water /~ +/~'~' Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I cert/'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the. da~te,of this inspect/on. Date ¢' ~-' ~ ~- HAAFee$ ~.,./0 Date of Payment Receipt Number ,/// 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~") ~.'"~ - t ,~ ~~ \Lo NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b)' Property owner Mailing Address J"/g ~ ,~ . h . pT.elephone: (home) (c) Lending Institution Telephone Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here,~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms --~ Single-Family [~ 3. WATER SUPPLY Individual Well J~ Community [] Public [] Note; If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval 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 Date Telephone /J/,-', ?? 6. DHHS APPROVAL Approved for .-~ bedrooms by Approved ...'~. _ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 inordertosatisfycertain federal and state requirements. Employees of DHHSdonotconductinspections 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. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification MU~i~IPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: Well Log PresentCN) _Date Completed Total Depth/,¢'-() Cased to ,/¢~ ' Depth of Grouting . Static Water Level ¢7 ~' ~ Casing Height Above Ground / / Electrical Wiring in Conduit (~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //~(~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by _ ,/~'-~/-I ~r~fqH'~fx Water Sample Test Results /~/~¢-- ~ ~ ~' Comments /,~E~/.~ F~-~ ~7'" If A, B, C, D.E.C. Approved (Y/N) ~ Yield ~-~ ~)~/"'/ ~' Sanitary Seal on CasingS/N) Depression Around Wellhead (YL'Cr~) ; On Adjoining Lots /~2E? ¢'/- //~_.,9C9 '-/- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date ("~/-/~ "~'~' B. SEPTIC/HOLDING TANK DATA Date Installed /[¢5-- ~¢~ Size Standpipes~N) Depression over Tank (Y/~ Pumping/Maintenance Contact on File (Y/N) /~//// ;for /L.)I,/,/] Holding Tank High-Water Alarm (Y/N) /~l/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /4:¢2~--~O ¢/~f- No. of Compartments ~ Air-tight Caps (~N) Foundation Cleanout (Y~) Date Last Pumped -k~ -~"' ~ '--~'/¢r~ ~ To Building Foundation To Disposal Field ~¢'- To Water-Supply Well /f~)(~ r ,L TO Property Line /O !4- To Water Main/Service Line /('.~ ~''/~ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field -~" Square Feet of Absortion Area Depression over Field (Y~) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: Type of System Design Length of Field Depth of Field /~-~ Gravel Bed Thickness ~,-- Statndpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well /(::::~ To Building Fo.undation /¢ To Water Main/Service Line /(~ 9- To Stream, Pond, Lake, or Major Drainage Course /(¢~)¢_..9 ~- To Driveway, Parking Area, or Vehicle Storage Area To Property Line /(:~ ,¥ To Existing or Abandoned System on ; On Adjoining Lots /~...~ To Cutback (if present) //~,~ Comments D.~TATION ~ia~tc.e i Inn~ , ,S ipZuer~ ~ ~',', °L eSv e i a t-'""'-~.....~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to alt MOA and HAA guidelines in effect on the date of this inspection. Date MOA No. 0~-¢ Receipt No ~,""~.~ z~c~ ~/'//¢¢c:~L /? Date of Pa;ment - .~'.Y¢~- ~'' /~.~' - Amount: $ // 2~--'~, ~ ~ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE ~ / DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4?44 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner Mailing Address (c) Lending In~tit'ution Mailing Address (d) //7/-~t-Z~'~f~///'~:~'i~' Telephone: Home c~('/~ '/7/ '"~ Business Telephone Real Estate Company'and Agent Address (e) Telephone ,~¢¢~ / '~/"7 // Mail the HAA to the followina address: or; Check here , if hold for pick up. List contact pe..r, con ~d day phon6~ number b. elow. , TYPE OF RESIDENCE Single-Family'~ Number of Bedrooms ..5 WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or w~,stewater 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 /-~'~'~'~") Telephone / Date "/:' Approved for .,'~x~.~x,~.? bedrooms by . Date Approved /..~_ Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 tRey 8/86) Back RECEIVED WELL DATA MuNICIPALrfY OF AN¢III~'I~IPALITY OF ANCHORAGE (MOA; EN¥1RoNMENTAL SERVtCEICDI~UTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 · ~ 1988 264-4720 Legal Description: Z.c'T'~ Well Classification ~/ Well Log Present~) Total Depth /~ / Cas.ed to / Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(~(4F~N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ,d//A Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed '~ ~ 7 ~' Yield /LS'"~ / Depth of Grouting Pump Set At / ¢' Sanitary Seal on Casin~) Depression Around Wellhead (Y~) ! / /~'¢ '¢' ; On Adjoining Lots /~0 /,/-- . / , On Adjoining Lots To Nearest Public Sewer To Ne~/'est Sewer Service Line on Lot /O ,'/" t~, tdl~l ;Date -'~ "&'~' Comments - SEPTIC/HOLDING TANK DATA Date Installed StandpipesON) Air-tight Caps ~1'4) Depression over Tank (Y~'N)~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~//~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Water Main/Service Line Course Size //~"d'E) No. of Compartments Foundation Cleanout (Y~) Date Last Pumped ,~''-,~0¢'~' ,,d'//~ ;for ,/_ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~ / '70 To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11184) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field 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 Type of System Design Length of Field ~:~ Depth of Field Gravel Bed Thickness ,..~.~ Standpipes Present~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots /O / To Cutbank (if present) Comments LIFT STATION "Pump On" Level at ~-A....,..~ "Pump Off" Level at High Water Alarm Level at ~~ Vent (Y/N) Tested for -'"'f%m;t~g Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~~ ' Comments ~~.... Company .,~'"d..--5 MOA No, Receipt No, Date of Payment 4 ~ Z'/~O¢'- ~ Amount: $ /7 6 0 0 Page 2 of 2 72-026 (11/84) INSPECTION APPOINTMENTS DATE DATE ~R~ DAT E~/( INSPECT '~' ,NSPECTOR ,NSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHOkAGI; DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'rlON D~-PT. O,F ;: ]i;I ,?~ 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~I~I~I~T~E~· DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE Curtis & Geraldine MockI 345-1666 MAILING ADDRESS SRA Box 4014, NHN Our Own Lane, Anchorage, Alaska 99507 PROPERTY RESIDENT (If dlfferent from above) PItONE Same As Above Same 2. BUYER PHONE Jerry E. & Dianne R. Hunter MAILING ADDRESS 608 Pine St., Anchorage, Ala~a. 99504 3, LENDING INSTITUTION I PHONE Alaska. Mutual Ba,z~k Attn: Debbie J°h~S°nI 274-2551 MAILING ADDRESS 1503 West 31st St., Anchorage, Alaska 99503 4. REALTOR/AGENT I PHONE Jack White Co, Attn: Joe BabkaI 277-155~ MAI~LI NG ADDRESS (,ala±s Office Center, 3201 C St., Anchorage, Alaska 99503 5, LEGAL DESCRIPTION Lot 3, L.a..mb Subdivision STREET LOCATION NHN Our Own Lane, Anchorage, Alaska. 99507 6. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [] Three [] Six [] Other 7, WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *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 [~3 INDIVIDUAL/ON-SITE** 1 9'79 [] PUBLIC UTI LITY ~//5-'/7~' YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE ..?/-THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY E3~INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~DIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or I~] Holding Tank Size:// o~zD, If Tank is homemade SOILS RATING give dimensions: J TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL "" 4, DISTANCES Septic/Holdin,~Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: / g:) "~ / Absorption Area to nearest Lot Line 5. COMMENTS E~._~.P, PROVED FOR ~:~- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 {Rev. 6/79) ' DA~F RECEIVED \\ INSPECTION APPOINTMENTS TIME TIME TIME DATE//', /5 - (~ ~-~..~/d,/-//tLJ' DATE DATE I NSPECTOR~ I NSP ECTOR INSPECTOR MUNICIPALITY OF ANCHO~GE MUNICIPALITY OF ANCHORAGE DEPT OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~:~ON~ENTAL PROTE~ION 825 L Street - Anchorage, Alaska 9BSO1 ENVIRONMENTAL SANITATION DiViSION OCT 3 0 1979 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. 1, PROPER~OWNER ~. /~ I PHONE MAI LING ADDRESS PROPERTY RESIDENT (If different from PHONE 2, BUYER PHONE MAILING ADDRESS 3'.' ~ENDING INSTITUTION J PHONE I MAILING ADDRESS ' 4, REALTOR/AGENT [ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~'~SI NG LE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER S~pPLY [~]' INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach Icg if available.) 8. SEWAGE D~/~3SAL SYSTEM J~EIr/ INDIVIDUAL/ON-SITE /~ 7F. YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev, 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS = [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2. WATER SUPPLY {Z~ INDIVI DUAL 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 Connection Verified iNSTALLER []Septic Tank or [~] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL. ABSORPTION AREA MATERIAL 4, DISTANCE8 Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line 1 WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS E~APPROVED FOR , _~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY~ ~ 72-010 (Rev. 6/79)