Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SOUTHPARK BLK 3 LT 5
outhpark Block 3 Lot 5 #020-491-31 UBMITTAL V AUG S g 2014 Inspection Re)9p 1-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141203 PID Number: 020-491-31 ❑ New 0 Upgrade Name: MCCARTYHY GREGORY & CHASE WENDY ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed El Mound Address 16215 CHASEWOOD LN ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision SOUTH PARK Block Lot 3 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel widthBeds: Ft. Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ft' Number of trenches Dist. between trenches Ft. Well N/A N/A NA N/A TANK 71 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1000G,1. Surface Water N/A N/A N/A N/A Material Number of compartments Lot Line 41.6 NIA N/A N/A NA Steel 2 Foundation 14.6' N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal, Remarks Pump on level at in. Pump off level at n. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank 3034 Tankto 3034 drainfield A PLUS SERVICES Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) ft Insp1' 6/16/2014 dates: 2�a Location and description 3d 41h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ..... seven {� �anriorae l cfQS�s Approv Date Inspection Re)9p 1-1-12.doc ply -41 4 AREA (E) z H o J 17.3 w 'o 0 X9.0 J �w w w ma 3 Q J J J OJ Q 98.05 t794.05J- 4'0 93.46 1000 g SEPTIC 93.3 --4 TANK (E) LOT 6 1 1 / LOT 5 DETERIORATED SEPTIC TANK (E) ABANDONED PER CODE NEW 1000G SEPTIC TANK WITH DOUBLE CLEAN OUT INSTALLED T2 T1 3 BDR HOU/SEE i C2 14'8 DC1 DRAIN FIELD (E) CHASEWOOD LANE W O M LOT 4 SEPTIC AREA (E) J I 1 B Ti 17.3 53.3 T2 EA 19.8 X9.0 DC1 21.1 61.0 PC2 27.5 61.9 NW PANNONE ENG SVC LLC P.O. BOX 100217 ANCHORAGE, AK 99510• PHONE (907) 272-8218 FAX (907) 272-8211.. -- of q Ott . ( �qsl�� .�9�` �•... •. I % Steven R. ' Ponno'ne' j CE 8149 Date 12/15/2014 RECORD DRAWINGING scale P.I.D. NO 020-491-31 SOUTHPARK BILK 3 LT 5 G.RECORY MCCARTHY & WENDY CHASE 16215 CHASEWOOD LANE ANCHORAGE, AK 99516 PERMIT No. PLAN Sheet2 OF 2 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141203 Tax Code Number: 02049131000 Work Type: Septic Upgrade Permit Effective Dates: June 26, 2014 to June 26, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SOUTHPARK Site Legal Address: SOUTHPARK BLK 3 LT 5 G:3236 Owner/Address: MCCARTHY GREGORY A & CHASE WENDY 16215 CHASEWOOD LN ANCHORAGE AK 995164828 Site Mailing Address: 16215 CHASEWOOD LN, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 24700 Total Bedrooms: 3 N Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcell.D. 020-491-31 Property owner(s) Gregory McCarthy & Wendy Chase Day phone Mailing address 16215 Chasewood Lane, Anchorage, AK 99516 Site address 16215 Chasewood Lane Legal description (Sub'd., Block & Lot) Southpark, Block 3, Lot 5 Legal description (Township, Range & Section) Lot Size 24,700 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 1ZUpgrade nX Duplex (D) r-1Holding Tank ElRenewal E]Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well SUBMITTAL Water Storage ❑ JUN 16 2014 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. of property owner or Permit/Rush Fees: 21� Date of Payment: l Receipt Number: Oq Sy l Permit No. O`Je 117-03 Permit App_-'-:. :L.:c. Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@paneneak.com June 16, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Southpark, Block 3, Lot 5 Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon septic tank be issued for this lot. The proposed system will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for three bedrooms. The existing 1000 gallon septic tank is deteriorating and allowing solids to pass through and clog the outlet. The existing 1000 gallon tank will be abandoned per code. This lot is served by a Class 'A' water system. The surrounding lots are also served by this Class 'A' water system. There are not wells within 200' of this septic system. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 5 slopes from north to south at approximately 5% - 15% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot, to the east of the house, and next to the existing septic tank and absorption system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1,12 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 200 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 1.00217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 \ SEPTIC AREA (E) 70, \ \ 6 ; / . DETERIORATED SEPTIC TANK (E) LOT 5 ABANDON PER CODE INSTALL 10009 SEPTIC TANK (P) W/ DOUBLE CLEAN OUT 3BR f H(U)E h� E DRAIN FIELD (E) \ CHASEWOOO �\ ^^� O a q 7 G 2A NOTES: PAMONE ENG SVC, LLC TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SOUTHPARK, BLOCK 3, LOT 5 GREGORY McCARTHY & WENDY CHASE 16215 CHASEWOOD LANE PLAN ANCHORAGE, AK 99516 0 SEPTIC AREA (E) TI �a Date 4 Scale *..�� :* 1^ so' ,SY.' �✓ ,T'— 5 020-491-31 n R. Pannone / PERMIT N0. CE 8149 OSPXXXXXX Sheet 0 oFEssioN``� 1 of 1 72-013 (Rev. 3/78) -- -- Ji 1 , of 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 NAMEj \ � PHONE rr❑yyNEW MAI LI NGADDRESS gR509 LEGAL D ESOI/R��JJIaa6 fa -64--y ,j�'JP^` ^ LOCATIOPNO. LOCATIO OF BEDROOMS 3 DISTANCETO: W Absorption a a 2 t Dwelling ^o PERMIT NO. `7O`�37 O JJ O+ Y i 72 —Y a zQ Manufacturer Material No. of compartments wr r y Liq. capac't in gallons IF HOME E: Inside length �— Width .� Liquid depth �-' DISTANCE TO: Well Dwelling PERMIT NO. J t7Z O Z < Manufacturer Material Liquid capacity in gallons D u, DISTANCE TO: W II Foundation Nearest lot line/0 PERMIT NO.- �� W, LL Z F Z w No. of linD e t o e c line 7 Total length of li Trench width, 'nches Distance between lines - Q Top finish beneath ive 1 x of tile to grade /Material rile oral absorption , l7 r p2 inches Length Width Depth IT NO. /- e 6 UJ Q -11- Type of crib Crib diameter Crib depth Total effective absorption area na $APrDISTANCE Well Building foundation Nearest lot line TO: Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS nn SOIL TEST RATING r INSTALLER Exe- E><$y-a110 Y REMARKS I 1� ck n DO : OF HE LTH & �-u -7.3'�"IY f Z / G V /,C ENV R01, WVENI I•v I IWR T\ ET _ Com` - APPR ED DATE LEGAL Cir, K fisc rxr }�iF� P,K a1 S 72-013 (Rev. 3/78) -- -- Ji 1 , of PlIfIICiPALITY OF ANCHOFnuE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION u 5Z5 L STREET: ANCHORAGE: AK: 99501 264-4720 /ERMIT NO: 'HTE ISSUED APPLICANT: ADDRESS: CONTACT PHONE 840492 UPGRADE 05.'20/24 RON LEVINE P 0 BO. a 4-551 ANCHORAGE, AK: 99509 562-2139 LEGAL DESCRIP: SUBDIVISION: SOUTH PARK: ;FER.R. SECTION: 3 TOWNSHIP: i1N .LOT SIZE: .75A <SQ. FT. OR ACRES;, LOT LOCATION: CHASEWC iC iD LANE EST LOT: 5 RANGE: EW BLOCK: I CERTIFY THAT: 1. I;AM FAMILIAR WITH THE REQUIRE9EVT5 FOR ON—SITE SEWERS AND WELLS As SET FORTH BY THE MUN'iCIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2._I�WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS: AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. _. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL: WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT =NATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES: THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED, (2) AS—BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND '.=} THE ELECTRICAL WORK �: M T DOFdE .Y A LICENSED ELECTRICIAN. SIGNED DATE Z_2 -- --------------------- ------ — APPLICANT: RO4 LE'�/INE •ISSUED BYtiDATE:ry --- ----1-------------------------- Jff'PTrt 70 ®.Fs &o O f 'TA c 4 -os-, 6�� SOILS LOG NoV-el )/ MUNICIPALITY OF ANCHORAGE�ly� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /- PERCOLATION ((( TEST W) 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 900 LC v/tic DATE P D: 6 J l 8 LEGAL DESCRIPTION: Lot- S A/CCfc----3 sotiff, PIc- 7--a I SLOPE SITE PLAN 1 ' UC 6`�0.�rc Sm r 2 3 4 S yy)e-.ws ri Cobb IES 4(y,✓l�k�t� 5 6 7 9 10 11 12 13 14 75 16 17 18 19 20 COMM c' 3�'r WAS GROUND WATER ..i) L ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? ' Reading Date Gross Time Net Time Depth to Water Net Drop CERTIFIED BY: /3S 7 -6S /S"S' 2aS- /0 , fir/` F zr 5" r o `s 3 C 6 2r3 v _ �S� PERCOLATION A L 2 3�— rd (minutes/il .06 TEST RUN BETWEEN /� t3 FT AND 2— FT A PERFORMED BY: G r- _ �J OZ CERTIFIED BY: 72-008 (6/79) ALASKA MUIROWnTAL COnTROL SCR US, IX Engineering 6 Cnuironmental Studies JUNE 4 1984 RON LEVINE P 0 BOX 4-566 ANCHORAGE AK 99507 SELLER — RON LEVINE BUYER — SUBDIVISION — SOUTH PARK TERRACE ESTATES BLOCK — 3 LAT — 5 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS ACH- TH AN AREA OF 516 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTINd,160 GALLON"F WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 166 S. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A. HOME OF 3 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 9/27/83. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. ©� D&e Leroy . Reid, Jr. 4P� c° No 2257E y¢. `fif g'" � �- . 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • 907) 276-1361 1. MUNICIPALITY OF ANCHORAGE 1 ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW ❑ PGRADE MAIL& G ADDf S„ ` 6� 0A l If LEGAL DE CRIPTION .—o OT L-5- LOCATIO " � (�, /) N NO. OF B%Z, `OO..�3 U Y DISTANCE TO: Well Absorim reat Dwelling Oc, zo," PERT (- HZ wF Manufacturer ' ^� 7 NG �9✓ot-tilt/ Mater' (�� ./ -�!4J No. of apartments r�•�.• to Liq. cap �i allons IF HOMEMADE: Inside length Width Liquid depth �-' J t7Z DISTANCE TO: Well Dwelling PERMIT NO. 2 z F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well �' Foundation �j ` Nearestlotline b PERMIT NO.l . �_ o u Z F, z C No. of lines Length of a@h Ijne �t Total le g Il_of jnes �� ( Trench wh L. inches Distance bet ee li es ¢p p Top of tile to finish grade Material eneath file inches Total effective bsorption area W a Length Width Depth PERMIT NO. Q F W C Type of crib Crib diameter Crib depth Total effective absorption area m DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER - d Y PIPE MATERIALS 613r,_, ® SOIL TEST RATING Cj INSTALLER a REMARKS 1 A O E DATE LEGAL 72-013 (Rev. 3/78) V rdd 9_1 r -.d I e= I f=' @=gid F. 17 '." ®_) F07 f? NJ C? 44 CD FZ FA C3 E DEPARTMENT OF'-`iELTH FIND ENVIRONMENTAL Rl""TECTION 825 ''L 3TREET, ANCHORAGE: AK. 999 264-4720 PERMIT NO. 810430 ) Loa. APPLICANT RONALD LEVINE LOCATION CHASE WC❑=D LANE LEGAL LOT 5 BLE.: = SO. PO. BOX 4-566 ANCH LOT SIZE 26000 SQUARE FEET' TYPE OF SOIL ABS•ORPT'ION 'SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = = SOIL RATING (SS.! FT.'BR)= 150 THE REQUIRED SIZE OF THE SOIL AE:SOF:F'TICiP•t�5,'' , I y1r ! �2% 104 C3 F" FA % " F= L_ E> F= F-' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE: DEPTH OF A TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E';CAVATION 0N FEET::'. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION 0N FEET). FQ E: CA LJ I F= d = d> d. 1="-Y- 1 @= 1- FA VA d'= : — 12 =7 = A CA CA CA C3 FA L_ d_ Cl r'4 PERMIT AP'P'LICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIOP'S OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- ------ -r JAI CA "-_ no I VJ 10 d= ®_: -T- I C A r-4 _" F A FZ EE FR EOCI LJ I K EOE~" — — 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-S,ITE SEWAGE DISPOSAL SYSTEM I. 100 FEET FOR A PRI'vATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE_ WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO IN=URE PROPER INSTALLATION. F="KFw!r^l I T A E.'-eF=" I FQE:00 E>E= _ E r"-FE3E dT' "f I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS. AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON—;ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I_ REE t ELED TO INCLUDE MORE THAN 3 BEDROOMS. := I GNED . � _._..- �------- ----•---------- AF LIQ !NT RONALD LE':' INE I SSUE( 'y'4} 0 ALASKA TESTLAD Bounty Development Company SRA Box 470-B Anchorage, Alaska 99507 4040 "B" STREET; s . ANCHORAGE, ALASKA 99503!'` (907) 278-1557 May 9; 1980 W.O. #A-19218 Attention: John Berggren Subject: Phase I, Southpark ice Soils Investigation Gentlemen: We herewith transmit four copies of the subject report. The purpose of this investigation was to determine the feasibility of constructing on-site wastewater disposal systems. Design absorp- tion areas for the drain fields are given on a lot -by -lot basis. Sincerely yours, ALASKA TESTLAB James R. Finley, Jr., P.E. Geotechnical Engineer Approved by: JRF/mg Attachments cc: Dave Grenier, Tryck, Nyman & Hayes s" Melvin N. Nichols';•„�, No. 4113-E • �.aVo.J F,r . ........ F, .� Melvin R. Nichols, P.E. Laboratory Manager JRF/mg Attachments cc: Dave Grenier, Tryck, Nyman & Hayes s" Melvin N. Nichols';•„�, No. 4113-E • �.aVo.J F,r . ........ F, .� SOILS INVESTIGATION i SOUTHPARK TERRACE ESTATES SUBDIVISION, PHASE I ANCHORAGE, ALASKA j Prepared for BOUNTY DEVELOPMENT COMPANY Prepared by ALASKA TESTLAB Soils and Ground Water LOT 5, BLOCK 3 The soils consist predominantly of gravelly sandy silt. This was determined by Test Borings 5-3 and 36. No ground water was observed in the test borings which were drilled to a depth of 16 feet. Location of Septic System The preferred septic system location is on the south or downward side of the lot. Design Absorption Area A percolation test performed was in Boring 5-3. A percolation rate of eight minutes per inch. Thus, based on criteria in the "Manual of Septic Tank Practice", the required absorption area is 150 square feet per bedroom. D•eotn is Feet From To 0.0' - 6" 6" - 20.0' Bottom of Test hole: Frost Line: Free Water Level: Remarks: Soil Description Organic Topsoil. Gravelly Sandy Silt. 2.0.0' None Observed None Observed Percolation test hole in lower silt area. Remarks: 1. 2. 3. 4. 5. 6. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed, Dry Strength, N=None, L=Low, M=Pledium, H=High. Group refers to si-milar material, this study only. General Information, see Sheet 1. Frost and Textural Classification, .see Sheet 2. Unified Classification, see Sheet 3. Type of Dry Sample Depth M% Sample Strength Group Unified 1 2.5' G D ML 2 5.0' G D ML 3 10.0' G D ML 4 15.0' G D ML 5 20.0' G D ML Remarks: 1. 2. 3. 4. 5. 6. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed, Dry Strength, N=None, L=Low, M=Pledium, H=High. Group refers to si-milar material, this study only. General Information, see Sheet 1. Frost and Textural Classification, .see Sheet 2. Unified Classification, see Sheet 3. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-491-31 1. GENERAL INFORMATION S Expiration Date: •J a 3 oc 0 Complete legal description out" Park 03 L5 ' Location (site address) 16215 Chasewood Lane Anchorage, _AK Current property owner(s) Gregory McCarthy & Wendy Chase Day phone Mailing address Same ' Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well [] Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ J5O Date of Payment 3J`81 aoao Receipt Number 05100.61 COSA # 05C Q 61101 Date: Waiver Fee $ Date of Payment Receipt Number i Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER j 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system: under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date 1006-9Ga OF At ill �. y t 6. DSD SIGNATURE .. • • • -• System #1 Approved for -2—bedrooms " •s'teven nncne CE 8149 System #2 Approved for bedrooms �+i�1AF�os5io,�P��rr Disapproved � f�a�`�.� Conditional approval for bedrooms, with the following stlpulafions: OFCy IVT - - `' »)'�r )) " r A ffl By: Original Certificate bate: 3 a 3 a�-2d 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet E1 Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: South Park 133 L5 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite for 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. Comments 1 B. TALK DATA Age of tank(s) 6 years Tank typelmaterial Measured operating fluid level in septic tank 48" ❑E Standpipes/foundation cleanout per record drawing Date of pumping 2/10/2020 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 1984 ❑■ ALL standpipes present per record drawing Total measured depth from grade 10.0 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ NIA -- pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective s U Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 020-491-31 Structure served by this system 1 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 272"2" Results Q Pass For 3 bedrooms Fluid depth prior to test 16 in Water added 450 gal New depth 18 in Elapsed time 200 min Final fluid depth 16 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date if•] 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank ? 100' ❑ Yes if No ft Private SeweriSeptic Line ? 25' ❑ Yes if No Absorption Field on Lot ? 100' ❑ Yes if No ft Holding Tank ? 100' ❑ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment? 50' El Yes f Na ❑ Yes if No ft Manure/Animal Excreta Storage ? 100' Community Sewer Main ? 75' ❑ Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations ? 10' 0 Yes if No ft Surface Water > 100' ft ft ft ft ft Q Yes if No ft Properly Line ? 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field ? 51 r❑ Yes if No ft Private Wells ? 100' Q Yes if ND. Water Main ? 10'r❑ v❑ Yes if No ft Community Wells ? 200' 0 Yes if No_ Water Service Line > 10' Fv� 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' M Yes if No ft if absorption field is under driveway comment below Property Line ? 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main ? 10' r❑ Yes if No ft Private Wells > 100' Yes if No Water Service Line ? 10' v❑ Yes if No ft Community Wells ? 200' Q Yes if No Surface Water? 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 cerfify that ! have determined throtigh field inspections and review of Municipal records that the above systems are in conformance with MOR COSA guidelines in effect on this date. 20CB to CASA Checklist yellow sheet �� �F• A4 .q Tip s1tev2n - F'Onnone } CE 8149 I ems, ',ate ft ft ft ft N7T£ NO F.ASfA*NTS-4MAR ON THIS t0 i UN IMr RKC?mJ R: Al THE SURVEYDATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE OWNER OFRECORD AS OF THE DATE OF THIS SURVEY ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ��Qo�ppp off. 49 T 7�� dV. co ' ,; SHANE A. HOLT'.. VV4 LS -6914 �D A5-BUIL T SURVEY 1" =20' prOfessivna� NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY IOT.5, & OCA',; SOUTHPARh SUP,- (KA 83-65) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED - DATED AT ANCHORAGE,ALASKA THIS '`'TI' DAY OF FFORI 7 IARS 2020 74526, fS 20,7-462 HOLT LAND SURVEYING 9309 GRAVER DRIVE ANCHORAGE,AK 99507 345-5593 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE I. General Information (a) Legal Description (include lot, Location (address or directions) Application Date subdivision, section, township, range) (b) Applicants Name La0L 4P_D1 Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/bu*±deT ; Buyer =; Other =(explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Te Address°gyp% 1-5 dev4��yw Telephone AiG -/353 (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well M Community ZI Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite M Public [::� Community E::l Holding Tank E] 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] 5P 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 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 regula- tions in effect on the date of this inspection. Name of Firm ®kk�_" Addres Date l�ASt✓$-S --- (ENGINEER SEAL) 6. DHEP A� rp oval Approved for - bedrooms By Approved a/ Disapproved Terms of Conditional Approval CAUTION Telephone '_.2q 34/� OF Al 0 4 92 25-E aux �• 6.<e.. .. _P JUNE 25, 131-1 �TJate` • `-� eb � - Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAG,c DEPT. OF HEALTI'1 F< E VI::ONMENTAL P;',CTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) lANI 5 1985' CHECKLIST - FEBRUARY 1984 C'I' I V tr D Legal Description: LOT S� B K b A. WELL DATA Soca rH �A2K TE22AGL" se C H T11 N gAv/ Well Classification A If A, B, or C, D.E.C. Approved(Y/N) )/ Well Log Present (Y/N) N//.a Date Completed W/q Yield N/q Total Depth _____N/A Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around VLallhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 02 ab f On Adjoining Lots To Nearest Edge of Absorption Field on Lot -2-00 ; On Adjoining Lots__ To Nearest Public Sewer Line To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed `lm Size 1&v — No. of Compartments Two Standpipes (Y/N) 'j%&o Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped 6/z Pumping/Maintenanoe Contract on File (Y/N) N/A ; for Nll*v Holding Tank High -Water Alarm (Y/N) 141At Temporary Holding Tank Permit (Y/N) KLA Separation Distances from Septic/Holding Tank: To Water -Supply VAJe 11 '2 o t To Building Foundation /2. To Property Line 39 To Disposal Field Y 3 To Water Main/Service Lire to To Stream, Pond, Lake, or Major Drainage Course do NE Comments Receipt # Date Paid: 65 Amount: y —_ [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _a425 Type of System Design %&Elyr 1.1 Date Installed &/gy Length of Field Width of Field " Depth of Field 1 D Gravel Bed Thickness _ (� Square Feet of Absorption Area G Standpipes Present (YIN) _ Depression over Field (YIN) Date of Last Adequacy Test Results of Last Adequacy Test A(/�A _ Ne uP' UpG2ADE , 1Q8 Ll Separation Distance from Absorption Field: To Water -Supply tall 2" To Property Line ?;• O __ To Building Foundation `fD To Existing or Abandoned System on Lot Nt ma ; On Adjoining Lots '30 f To Water Main/Service Line I() + To Cutbank(if present) _ ►gyp N L To Stream/Pond/Lake/or Major Drainage Course N 013 L. To Driveway, Parking Area, or Vehicle Storage Area 50 Comments X S/'��Is�F p" ucaarR4A,-1 A t� 7 [. aA.aL. , aX A// -C.Z/I I , An / 91t;/ D. LIFT STATION No N E Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (YA) Pumping Cycles during Adequacy Test, Mets MOA Electrical Codes(YM) Comments ^ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ��� Date Company �� MOA No. ST-� KB1/d5/s [Page 2 of 2] Q q q4 • �l ^ s �fc RS �... J.•. a ... 6 e,• Na zz25-c p , w e zs, 9a�1.is'. _oie 2-15-84 E 0 F S N8, DEPT. OF ENVIRONMENTAL CONSERVATION i ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: 111s_/YS PWS I.D.#,>/ 3 z1 7-5-- BILL SHEFFIELD, GOVERNOR Telephone: !9071 Address: 274-2533 To Whom it May Concern: $� According to records on file in this office the 0.411& rul�� Water System is in compliance -with the State Drinking Water Regulations l Sincerely, MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Description (include Location (address or Application Date &'Z subdivision ion, township, range) (b) Applicants Name(�fJR l�yiiiP___ Telephone ✓/b e�5� Applicants Address (c) Applicant is (check one) Lending Institution � �- eJr/builder Buyer F�:j ; Other r::j (explain) ; _ (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone _ 2. Type of Residence Single -Family �— Number of Bedrooms 3. Water Supply 1-ki1ti-Family Other (describe) Individual Wb11 Community Public Note- If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedreams specified in this HAA ) 4. Sewage Disposal Onsite Public Commwnity Holding Tank Is the wastewater disposal system adequate for the number of bedrooms (No- (Page Y ) (Page 1 of 21 2-15-84 5< Engineering Firm Providinq Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all WA HAA Guidelines in effect on the date of this inspection. Signed ,[ Z- Name of /firm Telephone Address Signed by Aj Leroy Approval�b4a�wib�" 6. DHEP Approved for bedrooms By Approved Disapproved Conditional Terms of Conditional Approval _ -seyio Date The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the /�HAA to the following address: " ->1-�32 1 Y KB2/d5/s (Page 2 of 21 2-1584 MUNICIPALITY OF ANCHORAGE nDEPT. OF HEALTH & ENVI ROW//ENTAL PROTECTIOR MUNICIPALITY OF ANCHORAGE (-MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification I Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Legal Description: RECEIVED. B, or C, D.E.C. Approve Y N) V upleted Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (YIN) Electrical Wiring in Conduit (YM) Depression Around Wellhead (YM) Separation Distances from Fb11: To Septic/Holding Tank on Lot L 2d0 On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ; Date Water Sample Test Results CcmTents `k /7q -C A B. SEPTIC/HOLDING TANK DATA Date Installed _ Size /MO No. of Compartments a Standpipes dy N) Air -tight Caps Y ) Foundation .rCCleanout Y ) Depression over Tank ( ) Date Last Pumped �� :% to 3 Pumping/Maintenanm Contract on File (Y/N) �; for Holding Tank High -Water Alarm (YIN) /!f Temporary Holding Tank Permit (YIN Separation Distances from Septic/Holding Tank: To Water -Supply Well fi .2p To Building Foundation / To Property Line :5T��7 To Disposal Field To Water Main/Service Line + /a" af- To Stream, Pond, Lake, or Major Drainage [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata %�?� Type of System Design Date Installed _ Length of Field Width of Field Depth of Field Gravel Bed Thickness /p Square Feet of Absorption Area $//o Standpipes Present Y ) Depression over Field ( ) Date of Last rquacy Test Results of Last Adequacy 'Lest iloDC,bd 2" &4 Separation Distance from Absorpt�ield: To Water -Supply Well t RooTo Property Line ivy To Building Foundation To Existing or Abandoned System cn Lot A)IQ-- On Adjoining Lots 3Q To Water Main/Service Line + No 'e To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area M Connents D. LIFT STATION+--/VONC Date Installed _ Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for _ Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Company KBi./d5/s (Page 2 of 21 Date MOA No. STg:3_ O 2tl %m'a�v�M, 56 0Con90p C' y.90O // O<ne 9L rfi C. Reid, Jr. AQ ST o� No. 2251L a.• L-;-, U 3, Sum -F4 Pr.k T� etgcc— c-4 .i -a > 2-15-84 s�l��1L Qill I;1�!^ISC(I^I DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 To Whom It May Concern: DATE: p I. 1��'f PWS I. D. # BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 Accord 1 ng to records on f i,1 e i n th i s of f i ce the d�( L�1 y"�� !! (C12j� 1c-k� bjL�p,��Jj�yl0,\J Water System is in compliance with the State Drinking Water Regulations. Sincerely, 5. LEGAL DESCRIPTION - DATE RECEIVED INSPECTION APPOINTMENTS A AN TIME TIME TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DAT DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six INSPECTOR INSPECTOR INSPECTOR MUNICIPAL OF ANCHORAGEDEPP MUNICIPALITY OF ANCHORAGE T. T. OF iiE?.Cfil u O DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTW130NMENTAL ?.,QfECTION 825 L Street - Anchorage, Alaska 99501 • (;�4�2 i c� ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 91. ITI � REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWM� DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROOWNER //' PHONE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MA I DDR ESS G, _ / i=/ `/ _/ PROPERTY RESIDENT (if different from above) / PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION // f'c5 M1_. !c' %lL G4./ O EGG/�i./-�/ // /'. @i Pn PHON/E/� -) MAILING ADDR/yE/SSS 4. REALTOR/AGENT PHONE MAILINGADDRESS - 5. LEGAL DESCRIPTION - Jr STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ED Four ❑ Other l SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled 0 COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log:.if available.) 8. SEWAGE DISPOSAL SYSTEM - ��/ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 1Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: _/©0D If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [Ll---A'PPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79)