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Home My WebLink AboutCEARK TR ECeark Lot 1 Tract F #020-441-06 Municipality of Anchorage Page 1 of 2 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: SW990244 PID Number: 020-441-06 Name' Wastewater System: ❑ New ■ Upgrade Yewa CAREEN MUIR Address: 15725 KINGS WAY DR. ANCHORAGE, AK 99725 ABSORPTION FIELD Phone: (907) 440-2899 No. of Bedrooms: 3 El Deep Trench El Shallow Trench 13 Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depthfom nal gado: Ft. GPD/Sq. R Lot: Block: Subdivision: Depth to pipe bottom from original gm 8: Crevel pth beneath pipe: 1 TRACT E CEARK Ft. Ft. Township: Range: _ Section: — Fill added above original gmtle: Grwel length: — R Ft. Gmvel width: Number of linea: Distance between linea: WELL: ❑ New ❑ Upgrade Ft. R Classification (Private. A.9,13): Total Dep Cased To: Total absorptionPipe material: R Ft. 50. Ft. Griller. Date Drilled: Statin Water Level: Install Date installed: R Yatd:Pump Set At Caving Height Above Ground: TANK GPM R Ft. SEPARATION DISTANCES ❑Septic ■Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer.Capoalty ANCHORAGE TANK in gallons: 4000 From Tank Field Station Tank Sewer Unes Well — — — 75'+ 25'+ Material: STEEL Number of compartments: 2 SurfacWater - - - * - LIFT STATION Water Lot'Size — — — 5+ — in gallons: Manufacturer. Line 'Pump on' level at:ump Pump o Hlgh water atoms at: Foundation — — — 5'+ — Curtain N/A N/A N/A 20'+ UNKNOWN PMaks aectricol Inspections performed by: Drain Remarks: * TO BE RESOLVED IN THE SPRING OF 2000. BENCH MARK Location and Description: DHHS STAFF MADE SITE VISIT IN 12/99 TO ASSESS CONCRETE GARAGE FLOOR AT EAST THE SITUATION. END OF WEST GARAGE DOOR. Assumed Elevation: 100.00 Ft ENGINEER'S SEAL 90600 oF 0 * AWWC, INC. Inspections performed by: Dates: list 8/28/99 p ...... • ...0.0 2nd 8/30/99 ........ .... :... 3rd QO f A. ess; Department of Health and Human Services approval Q 009 C —7953 em0 .•• • ,moo � ••. Eo�d �fp� Reviewed and approved by: Date: - -ofl a, �a 0 o' ofessio \o, 040��000 72-013 Rev. 9/9 MOA 25 W ry0 a z I i \-4 INCH 501,117 PVC C p' 4) DLRIED, — — — — — — — — — 70' UT]UTY EASEMENT - — — — — — — — — — — — — — — — — — — — — — — ALASKA WATER AND WASTEWATER CONSULTANTS, INC.000�In 69028. ANCHORAGE, AK. 99 PHONE�: (907)37 uSITE 79/FAX: (907) 38-3246504 �O LEGAL DESCRIPTION: CEARK SUBDIVISION, TRACT E, LOT 1, (CECIL RAY CLARK HOMESTEAD) �+* ........... .. ...... TYPE OF WORK: DOCUMENTATION OF CURTAIN DRAIN G •• •••• Q re A. Grnes PREPARED FOR: PHONE NUMBER: O � CAREEN MUIR 440-2899 004. '. 7953 DATE: DRAWN BY: SCALE: PAGE: 4�erea..... �o� 042000 JAG 1 = 40' 1 OF 1 �0Pref 444000�0 CLRrA1N [9mN. 35 f0 5 FEETwm. 60ffOM I I I 4 INCH 501.117 PVC ELEVATION 15 Af LEAST 3 FEET PfXWfW I i (05034) , pLRIED LAMA FLOOR R VAfION, 4 INCH WORATEt7 w I I CLKAJN 19PAJN [9mNPIPE ON DOffOM, TWNCH 6ALY.PII,I.Ep wfH 17RAJNROCK ANI? 4 INCH MINUS RIVER ROCK TO I I OUTFALL WITHIN ADOUf IB INM5 OF 9Ff GROLINP 5I DACE, i I z I ON a 19OWNHILL 51MWALL OF TIf TRENCH PRIOR fO PLACEMENT OF a WRANROCK ANP RIVER FOa GRAVEL/ 5ANI7 MIX OF 501E WA5 PLACE 9 OVER T[f TOP OF TIS WAINROCK 50 A5 TO INT RaPf I ( I I LATERALLY MIGRATING WATER FROM TIf OPGANIC 5011,5. A "CAP" OF NATLRAL 51LT WA5 P1,11M9 OVER THE fOP OF fHE 5AND/ GRAVEL, I I I I \ I I i als„"G I I i A "°DST I I W L ENI? 01 LUMMN VKAIN, I I I CLWfAIN MN I I OUTFALL I i \-4 INCH 501,117 PVC C p' 4) DLRIED, — — — — — — — — — 70' UT]UTY EASEMENT - — — — — — — — — — — — — — — — — — — — — — — ALASKA WATER AND WASTEWATER CONSULTANTS, INC.000�In 69028. ANCHORAGE, AK. 99 PHONE�: (907)37 uSITE 79/FAX: (907) 38-3246504 �O LEGAL DESCRIPTION: CEARK SUBDIVISION, TRACT E, LOT 1, (CECIL RAY CLARK HOMESTEAD) �+* ........... .. ...... TYPE OF WORK: DOCUMENTATION OF CURTAIN DRAIN G •• •••• Q re A. Grnes PREPARED FOR: PHONE NUMBER: O � CAREEN MUIR 440-2899 004. '. 7953 DATE: DRAWN BY: SCALE: PAGE: 4�erea..... �o� 042000 JAG 1 = 40' 1 OF 1 �0Pref 444000�0 Q cn z ( li I w ICL�TAN WAN 2.1 OUTFALL V00'+ TO FACE WATER 0 � I I I I I I i + CURTAIN DRAM. 3.5 TO 5 FEET W M. 60ffOM 4 INCH 501.117 PVC ELEVATION 15 Af LEA5f'5 FEET LWIV TfIC C 03034) , T3LRIED CIARAGE FLOOR ELEVATION, 4 INCH PERFORATED DRANPIPE ON POrTOM. fff NCH PAXILLED WITH DPANROCK AND 4 INCH MINLIS RIVER ROCK fO WHIN ABOUT 18 INCHE5 OF THE GROUND 9MA9, A WATER PROOF GEWX%I FADRIC WAS PLACED ON THE DOWNHILL 51MWALL OF ME TRENCH PRIOR TO PLACEMENT OF THE DRANROCK AND RIVER ROC GRAVEL/ 5AND MIX OF 501L WA5 PLACED OVER 19 TOP OF THE DRANVOCK 50 A5 fO IWRCEPf LATERALLY MIGRATING WATER FROM TH1 ORGANIC 501L5, A''CAP'' OF NATLM 51LT WA5 PLACED OVER flf TOP OF THE 5AJD/ GRAVEL, EkIS77NO HOUSE \ CL6RrAN 12MN OUTFALL �5 1 W L ENV OC� L WrAN DRAN, 05 / i I I \-4 INCH SOLID PVC ( 173034) PWIM L_+--------- --- 10' UTILITY EASEMENT DATE. op6o�pp 7/11/2000 nF AA v%. ALASKA WATER & WASTEWATER K.D.W. CONSULTANTS, INC SCALE: 6901 DEBARR ROAD, SUITE 20 • ANCHORAGE. AK 99504' PHONE (907)337-6179 • FAX (907)338-3246 1 = 40' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CAREEN MUIR (907) 440-2899 1 OF 1 LEGAL DESCRIPTION: CEARK SUBDIVISION; TRACT E, LOT 1, (CECIL RAY CLARK HOMESTEAD) DOCUMENTATION OF CURTAIN DRAIN *::.�. ��.—r. a..:::� ., A. Gayness: E-7953 m� •tic°O ..... I AIV PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW990244 020-441-06 LLJ fy D Q U) 0 Z Y IMCf fMK- A11W-9+00 SURFACE WATER ISSUES TO BE RESOLVED IN THE SPRING OF 2000. I ( II NEW 4000 GALLON HOLDING TANK ter.: n I M I I /rro�un.�rr�zaa2 NSW 41000 GALLON HaVNG TANK /A B GROif OM H USE S F i ST2 .: WELL ALARM 11 DBL1 I 17 I t DB ASSUMED WER SERVICE LINE. LOCATION LOCATION / o OF SEWER LINE IS UNKNOWN. / A B DBL1 27.4 79.1 DBL2 27.6 79.5 ST1 28.4 80.3 SU 37.6 87.8 ALARM 43.5 92.4 L_--_—®---_ __..a--_--_---®- 10' UTILITY EASEMENT _ — — — — — — _ — — e ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SURE 2B. ANCHORAGE, AK. 99504 0 0 PHONE: (907) 337-6179/FAX: (907) 336-3246 O �• I •. S4o LEGAL DESCRIPTION: •� DO CEARK SUBDIVISION, TRACT E, LOT 1, (CECIL RAY CLARK HOMESTEAD) 0*- ...................� TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE••. •... •.•.......� PREPARED FOR: PHONE NUMBER: f re A. G ness•= p CAREEN MUIR 440-2899 �� E 3 4� °o DATE: DRAWN BY: SCALE: PAGE: 4Oe�edP�� 12/13/99 A.C.G. 1 = 40' 2 OF 2 ooOQO0�0rofessi°Oo l6 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade P1-YA A-=1- ta/ �,1 �✓l f. Date Issued: Aug 03, 1999 I, Expiration Date: Aug 02, 2000 Permit Number: SW990244 Parcel ID: 020-441-06 Legal Description: CEARKTR E Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: Owner Name: Careen Muir Lot Size: 99000 SQ. FT. Owner Address: 5800 TRAPPERS TRAIL ROAD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-2401 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 1t�,I/I t� C� Received By: n s DA AQ `C20, Date: Issued By: &Lz i. Date: Municipality of Anchorage Department of Health and Human Services 16 825 "L" Street Mayor Rick yrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us August 4, 1999 Jeff Garness, PE _ Alaska Water & Wastewater Consultants, Inc. 6901 De Barr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Tract E Ceark Waiver Request #WR990048 Parcel ID #020-441-06 Permit #SW990244 Dear Mr. Garness: Your request for a waiver of the required 100 feet horizontal separation from the on-site wastewater disposal system to surface water has been approved. The approved separation distance is 80 feet. This waiver approval applies to the existing on-site wastewater disposal system to surface water separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, r Daniel J. Rot Civil Engineer On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR990048 PID# 020-441-06 HA# Permit # Date Received: July 29, 1999 Legal Description: Tract E Ceark Engineer: Jeff Garness, PE, Alaska Water & Wastewater Consultants 6901 De Barr Road Suite 2B Anchorage, Alaska 99504 Applicant: Careen Muir Waiver Requested: holding tank to surface water of 80 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for above: 5 FE fA/(,/yEE/1' f 19 DDW CA%a LEITER OF Tu3TiF1097-101V, Date: 8--4 —77 By: P6 Al Name of Reviewer Rec #: 05216/7202 Amount: $ 625.00 Date Paid: July 29, 1999 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B - Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers July 24, 1999 Municipality of Anchorage Department of Health and Human Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Ceark S/D, Tract E, Lot 1- HOLDING TANK To whom it may concern: The existing 4 bedroom house is served by a private well and a septic system that consists of a 1250 gallon septic tank and a deep trench. The trench is extremely surcharged and is surfacing effluent. The septic system will need to be upgraded prior to obtaining a Health Authority Approval from the M.O.A. One test hole was excavated on the property to a depth of 6 feet. The soils were visually rated as impermeable and groundwater was found at 3.5 feet below grade (see attached soil log). Based upon our assessment of the site, it is unlikely that there is any suitable accepting soils (2 feet unsaturated), as required to install an onsite septic system. It is our recommendation that your department allow us to install a 4000 gallon holding tank. According to the property owner, it is not possible to get a pump truck up to the house in the winter time. The tank will need to be located as far down the driveway as possible, which will require that the tank be closer than 100 feet from surface waters. The tank will be located on the northwest side of the driveway and 75 feet away from the well. There is a creek 110-120 feet to the south of the proposed holding tank and another creek is located 80 feet to the west (see attached design drawing). It is our opinion that there is no other option for the location of the holding tank, and a 80 foot waiver is requested. This will be a significant improvement over the current situation. A copy of the proposed design is attached. If you have any questions, please contact me at 337-61179. P.E., M.S. i i t I ) i II i Ili TRACT F, CEARK S/D (CECIL RAY CLARK HOMESTEAD) 18 /moi II / i ! � I j I, PROPOSED 4000 ! j \ GALLON HOLDING TANK( LOCATION : DITCH —EXISTING FOUR BEDROOM HOUSE EXISTING SEPTIC SYSTEM TO BE ABANDONED COMPLETELY. CREEK TRACT G, CEARK S/D (CECIL RAY CLARK HOMESTEAD) TRACT C, CEARK S/D (CECIL RAY CLARK HOMESTEAD) e ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 ✓` LEGAL DESCRIPTION: CEARK SUBDIVISION, TRACT E, LOT 1, (CECIL RAY CLARK HOMESTEAD) y/ TYPE OF WORK: SITE PLAN 7 PRECAREEN MUIR N BY: SCALE D44O-2899 PAGE: /JrrJ(,(,el DATE: DRAW i� 7/24/99 A.C.G. 1 = 100' 1 OF 2 Nk I •,r* y `G¢�ness: E-7953,: `c v G APPROXIMATE DITCH TH 1�) NOTES: O WING WATER FROM CRI EKS. CONTRACTOR SHALL HAVE THE 75' WELL RADIUS AND THE 80' SETBACK FROM THE DRAINAGE DITCH TO THE WEST FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. ( ' 2) ALL SURFACE WATERS OTHER THAN THE CREEKS ' SHOWN ON THIS DRAWING THAT ARE WITHIN 100 FEET 100SETBACK OF THE HOLDING TANK SHALL BE FILLED WITH SOIL. (APP X. LOCATION) / F F0Fy n ( / B INSTALL FOUNDATION OROOA, HO SE CLEAN-OUT p� CD €{ CO ^ I I WELL 100' WELL RADIUS ° ALARM — — — — — 80' VER E — J E(EUESTED� 3 ( f CO ° PROPOSED 4000 GALLON / HOLDING T� o SURFACE WATER IN DITCH TO BE �Y / CULVERTED AND COVERED WITH SOIL / p WITHIN 100' OF PROPOSED TANK. I y � e j ee I� CREEK (APPROX. ems' EXISTING SEPTIC SYSTEM TO LOCATION) / BE ABANDONED C OMPLETELY. f _ / //m 10' UTILITY EkSEMENT I ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 00060000 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 P "" •• PHONE: (907) 337-6179/FAX: (907) 338-3246 00 ..•••" S�pOo 0 LEGAL DESCRIPTION: CEARK SUBDIVISION, TRACT E, LOT 1, (CECIL RAY CLARK HOMESTEAD) - TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE p O f A. G ness, �0 E-7953 004s •. ;'\camp PREPARED FOR: PHONE NUMBER: CAREEN MUIR 440-2899 O fates o • • •' • i F'coO SCALE: PAGE: DATE: 7/24/99 DRAWN BY: A.C.G. 1 = 40' 2 OF 2 4�Daprofessio�o� o OpoOoo�� a• ^ ^\ ^• T CT , C RK /D CECIL RAY LAR HO ST D) AP ROXI 7E L CATIO 0 D NAGE ITCH TRAC G, C K S/D ( EC RA CLARK DME EAD ED R DOM HO E ^ DRIVE Y 1 Or W D. RADIUS EI (STING PTIC YSTEM TO BE ABAND NED OMPL ELY. �j CREE TRACT C, C K S/ ( CIL CLAR HOM STEA S &DWAS W TE NSU NC 901 EBARR R D• SU E RAGE, AK,i9 H .ANC NE: (90 337 61 /FAX: 07) 33 3246 - O '•� *T I LE L 5 ON: C A SUBDIVIS ON, TR/CT//OT 1 (CE L R C RK OME D .................... . „*O�� TYP OF W RK: SI E PLAN ...... ......... .s...... QO P •• PRE E F R: PONE NU ER: CA E N MUIR 440 2899 s ^�OpO 4oaPro.. •Ssion000 ATE: / 8/9 DRA BY: G. ALE:1 1O PGE: OF •C. QO ��O I! _ MUNICIPALITY OF ANCHORAGE i / • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION / p ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW 0-) it 0 f, .h ❑ PGRADE MAILIN AD/D/RESS 0 ,, -7 LEG L DESCRIPTION U,1 T �T LOCATION c� � a UY DISTANCE TO: Well ! � �-f-- Absorptio wLU Q Manufacturer �4�� ~ PERMIT NO. Liq. c p cit in gallons IF HOMEMADE: Inside len 6 Z DISTANCE TO: I Well Dwell' g Ja eneath tile inch Total effectOg absorption area �6 _ Manufacturer W = DISTANCE TO: Well Foundati J LL Z No. of lines / Length o�eacli lyne Total len Z ((pp �W Top tile to finish Material b of grade F7 - q Length Width Depth W (9 Q F Type of crib Crib diameter Crib dept wa W W Well Building f DISTANCE TO: Class Depth Driller J W DISTANCE TO: Building foundation Sewer line OTHER PIPE MATERIALS A ) / 7 Z03 e-49T.z�,J SOI L TE,RATING ly19 INSTALLER REMARKS k) ed, C) on gih (p NO. OF BEDROOMS 1 area Dwelling /AL5_ PERMITNO.9� y MateriS— --iCEL No. of cmtments gth Width Liquid depth PERMIT NO. Material Liquid capacity in gallons _ / I Nearest lot line/0 % PERMIT N-0. �+j� of Ii� (p Trench.uyic�h �i c7(n inches Distance b�tw en lines �(J eneath tile inch Total effectOg absorption area �6 ['PERMIT NO. h Total effective absorption area oundation Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) PPROV D DATE LEGAL lc-�,l /S/7f 72 (Rev. 3/78) M U " X Ia.- X F� " L- I -T l -e C-1 F= " r-4 17-: " Q F -r,* " f-3 F= DEPARTMENT HEALTH AND ENVIRONMENTAL ]TECTION 825 'L' STREET, ANCHORAGE, HK. 99!�ao1 �ow o�4-4 T~ --' ''-- w I -ir :E. F= F=E=- PERMIT NO. ( 780482 ) //&� / APPLICANT WM WILCOX P.O. BOX 6745"/'-'' .� ]49-56 LOCATION ~ - LEGAL GOY L 1 SEC 6 TRCT E T1IN R 2W LOT SIZE 108900 QUARE x4j TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCHLl MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (SQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION M IS: E7, EE F=p -IF " --L `:' L- EE r-41:3 -1F "= �F:;Z " 'v -P E: L- L-3- F-= F:=' -r�=�� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEETX THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN H FHLL PIPE AND THE BOTTOM OF THE EXCAVATION (%N FEET). - .-' 6 - 2 X�f 6!!! ��11 1 F?- FE L-:, F= F=* -r 1 17-� -r F=l r-4 K �I =- FEE= ��-4 -EF. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE ___ -FWC-1 <;2 > 1 ":5 F=" a: f--- -1F I RD " F-C'E: F;:?- I=- C-! U I F;;-* E-=: UK BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��f;?.M I -T �XF:-- I F;?.E-=:=- �� :IL:54 _7 c-- I CERTIFY THAT 1: I HM FHM%LIARWITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH By THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS SIGNED: ___-_-------------- I5SUED B - ��____DHTE_��____ �� LlOmibruetion gest IuLr "Ona test is worth a thousand opinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For H.V. Lounsbury & Assoc. Date Performed 5/26/76 Legal Oescrintion: Lot E B1ocl: Subdivision Ckark Subdivision This Form Renorts Soils Loo Percolation Test_yes Denth Feet Soil Characteristics _ Organic Topsoil, wet 2 (ML - PT) 4 Silt, wet (ML) 6— U N 8— S4 H 10- 12 0-12 — 14 — Silty Gravelly Sand, moist (SM) 16 Bottom of Test Hole 18- 20— Was (=round Water Encountered? No If Yes, At what Denth? Readinq Date Gross Time Net Time Percolation Depth to H2O inches I Net Dron' inches 6-1 0 72 i-- 6-2 132 60 _ 6-2 0 72 0 _ 6-2 180 min 79 7 6-2 210 min 80 1 6-2 240 min - 81 - Percolation Rate 1"/30 ►Minute Prnnosed Installation: Seenaae Pit Drain Field _ Depth of Inlet Denth To Bottom Of Pit Or Trench CnMtAENTS: 250 square feet drainage area required per bedroom _ No ground water or bedrock encountered. Test Performed By r�� /�%.'C;C4t_ Data Certified By CONSTRUCTION TEST Date: 6/7/76 _ WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGE DEPT. Of HEALTH & WELL OWNER �►� 1�i 10,DX USE OF Wt RtNM AL 1'Y1 ION L �_, &o'M � �, -1"/) , J n / ' ,/ LOCATION 1 Dr l. SC_A� •�DY� �. / /) A . R,9 W . � �'"I ON 21978 oErEIVED SIZE OF CASING " DEPTH OF HOLEc§iLFT. CASED TO FT. STATIC WATER LEVEL___jg_FT. YIELD__GAL.PER.MIN. WITH �.5� FEET OF DRAWDOWN. REMARKS DATE COMPLETED 1 — a'U-= %� PUMP TO BE SET AT j2t o-1- 'z—t Agt 4p za �� /)y O o fig t0 t0 t0 td t0 t 0 t0 t0 t0 t0 t0 t0 to t 0 2�1Uay a�k��4 CAsAC- 10U q7- Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-441-06 1. GENERAL INFORMATION Complete legal description CEARK Tract E Expiration Date: & - _ �; - / 5 - Location (site address) 15725 King's Way Drive, Anchorage, AK Current Property owher(s) Park Place Securities Day phone 261-7603 Mailing address same Real Estate Agent Bob Brock Day phone 261-7603 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: �Y, �f Date: S 2 5 J-5 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Feeln'gL. Wi_ Date of Payment Receipt Number Q �?q !� COSA# 05cln100 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. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stovon W. Eno By: A J-1-111 ( z/// / G Original Certificate Date: The Municipality of Anchorage Devlopment 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 COSAbluesheet 9-1-12.doc Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Ci�AR(c S/rD 'MAC T E ParceIID:QZd-4&&_ 06- A. 6A. WELL DATA Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed %G%36� Sanitary seal (YIN) Wires properly protected (YIN) Total depth 5 to ft. Cased to 53 ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION A_ Date of test Static water level /00, ft. 0 Q ft. Well production 3 g.p.m. Z g:p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate a. 23mg/L Arsenic At b ug/L Date of sample: 2 2d !S Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed 2 Tank size 006 gal. Number of Compartments _/ Cleanouts (Y/N) y/ Foundation cleanout (YIN) Depression over tank (Y/N) __zV_ High water alarm (Y/N) Date of pumping (v / Pumper / S 44 C 3 C. ABSORPTION FIELD DATA Afit Date installed Soil rating (g.p.d./ft2 or flz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ftz Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. .z Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION �I/1 Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot VX Absorption field on lot A/A Public sewer main il14 On adjacent lots /10 /1 i f On adjacent lots Public sewer manhole/cleanout �>✓A Sewer/septic service line 2,5''r' Holding tank Animal containment areas So -'t Manure/ahimal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation %D /& Property line Absorption field Al Water main /0 f Water service line �G it Surface water hod rr Wells on adjacent lotslee) t ABSORPTION FIELD ON LOTTO; Property line Building foundation Water main Water Service tine. Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. 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. Engineer's Printed Name 4,06- Date ,06'Date COSA yellow sheet 2-6-15.doc Parcel I.D. # 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING �}/� 020-441-06 HAA It 1. GENERAL INFORMATION Complete legal description Tract E Ceark Subdivision Location (site address or directions) 15725 Kings Way Drive Anchorage, AK Property owner Careen Muir bay phone 727-2289 Mailing address 5800 Trappers Trail Road Anchorage, AK 99516 Lending agency Mailing address eno.,r D �ilirace Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank XX 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(fiw"1) Front MOA021 ALASKA WATER F& WASTEWATER CONSULTANTS, INC. -- - --- December 9, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Rei Conditional Health Certificate for Ceark S/D, Tract E, Lot 1 To whom it may concern: The existing 3 bedroom house is served by a private well and new holding tank. The permit for the holding tank installation (SW990244) required an 80 feet horizontal separation to the surface waters west and south of the new tank; however, during construction this was amended to all surface waters. Presently there is surface waters closer than 80 feet to the north of the tank and possibly along the driveway. It is impossible to verify all potential surface waters at this time because of the winter conditions. It is assumed that the following will need to be done in order to resolve the surface water issues: Install a subsurface drain to the north of the holding tank, at the bottom of the existing swale, so as to intercept all surface/subsurface water that within 80 feet of the holding tank. This will require the installation of a culvert/drainpipe that is buried in drainrock, covered with filter fabric and soil (to protect from freezing). Install a drain along the right side of the driveway (as you drive up it) so as to eliminate the presence of any surface water along the driveway that are within 80 feet of the holding tank. This drain should daylight at the drainage ditch near the road. Fill any areas that have ponded water in them that are within 80 feet of the holding tank. The contractor is responsible for the sizing and construction of the aforementioned drains so as to ensure they are functional for the purposes intended. In addition, the following work must be done: The soils cover over the septic tank has settled, forming a depression. This must be filled. The well wires need to be buried (between the house and the well) and the wires put in conduit where they run up the well casing. 6901 Debarr Road, Suite 2-11 * Anchorage, Alaska 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * awws@alaska.net AW WC, Inc. will perform a final inspection, after break-up, in the Spring of 2000 to confirm that all of the surface water issues have been resolved. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your 6901 Debarr Road, Suite 2-13 * Anchorage, Alaska 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * awws@alaska.net RECEI Municipality of Anchorage DEC 1 199 DEPARTMENT OF HEALTH & HUMAN SERVICE,,,,,,,,,, ,,Aiv Environmental Services Division ENVIROM"TAL SERVICEn 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 ZHeallttth Authority Approval Checklist Legal Description: �Y�C/ - lgarP, -5/P Parcel I.D.: A. WELL DATA Well type PrILN& If A, B, or C, attach ADEC letter. ADEC water system number Log presentYY ) Date completed Al - 36--7 Total depth Cased to �J Casing height (above ground) ,, // Wires properly protected (Y/N) lk See Cand firona-e AT INSPECTION Sanitary seal ON) Date of test Static water level Well production FROM WELL LOG -36-76 9/ g.p.m. u 12 1- e- 451 1.3-+ WATER SAMPLE RESULTS: Coliform Nitrate �` �' fig/ L Other bacteria esample- Date of sample: 11-cg-gq 6.b, 1d -7-9g Collected by: AW UIl c B. SEPTI OLDING TANK DATA Date installed * -Z6' Cq Tank size 411640 Number of Compartments 2 Cleanouts(Y N) --7Y Foundation cleanoutCY)N) V* Depression (Y/N) High water alarm (Y N) Date of Pumping tjL960 Pumper � DouatF– d L6–,,ej–ULA� C. ABSORPTION FIELD DATA <lKsc Pn luti lro Tr Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) Sy type Length Width Gravel thickness below pi Total depth Effective absorption area Monitorin�ubepr (Y/N) Depression over field (Y/N) Date of adequacy test Res For bedrooms Fluid depth in absorption field befor st (in.); Immediately after_ gal. water added (in.): Fluid depth il I.� Minutes later: Absorption rate = g.p.d. Peroxide tre ant (past 12 months) (Y/N) If yes, give date (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level Cycles E. SEPARATION DISTANCES on" level at' 'Datum gallons SEPARATION DISTANCES FROM WELL ON LOT TO: r� / Septic/holding tank on lot / /5 4— On adjacent lots Absorption field on lot On adjacent lots "Pump off" level at` r iDa �- /DU Public sewer main /I e�t— Public sewer manhole/cleanout /17 CZ— Sewer Sewer /septic service line 5 7'" Lift station 17/6R�— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation _ J �— Property line 5 Absorption field /7 a i Water main/service line -- I Surface water/drainage Wells on adjacent lots 010 f _ SEP RAS TION DISTANCE FROM ABSORPTION FIELD ON LOTTO: *-'see eve) tn��t YlO✓1 Propery line _' ��'—`"—Building_fo�dation Water main/service line ' `G Surface water Driveway, parking7vehtcle-storage area Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that in conforma inspections and review of Municipal .s in effect on this date. Engineer's Na4eV Date (2 113 HAA Fee $ �� Waiver Fee $ Date of Payment_ �'1 ,/ — 91? Receipt Number_ 77 %O / 74 72-026 (Rev. 3/96)' Date of Payment Receipt Number [y A. on Ula/9N are 12-12-99 15:58 FROM -CTE ENVIRONMENTAL 5615301 T-493 P.01/01 F -69T /CT&E Environmental Services Inc. i1(� Laboratory Diviaian 200 W. Porter Drive Drinking Water Analysis Report for Total coliform Bacteria Tea(907) 562 234 6,9•f5os Fan; (4071 SGI -5301 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLI?CTING SA PLE O BE OMPLETE BY LABORATORY MUST BE COMPLETED BY WATI R SUPPLIER Analysis shows this Nater SAMPLE m be: ❑ PUBLIC WATER SYSTEM I.D. 0 1,�f Satisfactory tge PR[VATF WATER SYSTEM p Unsatisfactory F s O Sena lnvotce 13 Sample over 30 hours old, results may be unreliable °� ❑ Sample too long in ttanxir sample should not be over 48 hours old at exatmnanon AT ll& Please send I Bi WNS1�W nw �pleu„ia se��lfl delivery maail.6801 DEBMRRD.. SUIM 2BnartReceivedrzTime Reedved ❑ Sano!letda o sena rePetc. Apalyti! Began `�\ AIASKAR►A'PI%R 8t W Aaalytical Method: MM McGilrer °v 6901 DEBARK RD., SUr1E 2B • Number of colonte5/100 tnl. rr -�^- - Result• Analyst SAMPLE DATE: M1 /ol �l Day Year ssGjrsOrs SAMPLE TYPE: Fbks Jun ❑ Routine Q Treated Water Faxed a Repeat Sample (for routine sample Untreated Water T: Date: with lab ref. ao. Client aoti ❑ Special Purpose Collected Red of unsatisfactory resale: Time Collected El SAMPLE LOCATION I Collected KBy Phoned spww With Faud Date: T,mc PL•ID PrwI - - - "C FRIOLO GJCA: WATER ANALYSIS REQ - MMO•MUGResun: ToWColiform L can � Count t� - Caloalesi190 no MembmaeFilter.. Direct TN7C-Tpa .Mn TsCa.v Verification: LTB BGS COLIFIRM os -oma.. Fecal Coliform Coafirmadon _ coliform/100 ml FioalMembrapeFilter Results 0633) bra Reported By 13K_1LZ e, Tlme T Memhef d(Tha$G$Greup l5onme Ven��•mau,.a„e.•-, _ _ ___ .-. -. -_... ....�..o�.-. �. mm�s �uiNOiS. MAflVU1Nn, MICHIGAN. MISSQUai. NEW atiRSkY, OroO. WEST Len- viRGHA CME Environmental Services Inc. CT&E Ref.# 996379001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# Ceark Tract E L 1 Kitchen Sink Client Sample ID Ceark Tract E L 1 Kitchen Sink matrix Drinking Water Ordered By PWSD) 0 Parameter Results Total Coliform �xic u Nitrate -N 1.89 Client PO# Printed Date/Time 11/23/99 15:07 Collected Date/Time 11/19/99 11:00 Received Date/Time 11/19/99 12:20 Technical Director: Stephen C. Ede Released By " ALLouable Prep Analysis PqL Units Method - 'Limits -Date'- Date Init SM18 92228 .11/19/99 JDT- 0.500 m9/L EPA 300.0. 10 max 11/19/99 11/19/99 SCL MUNICIPALITY OF ANCHORAGE ® '1 DEPARTMENT OF HEALTH & HUMAN SERVICES a Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 1 (907) 343-4744 v., CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAM,IILLgY DWELLING) Parcel l.D.# 020-441-06 HAA #K///9�6W 1. GENERAL INFORMATION Complete legal description C ARK S iRnnac10N* TRACT E Location (site address or directions) 15725 KINQS WAY DRIVE ANCHORAGE AK Property owner TOM THnbdAS Day phone (9_07) 271-3996 Mailing address 15725 KINGS WAY DRIVE ANCHORAGE AK Lending agency Mailing address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank xxx Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Fmnt MOA #21 Computer Version 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 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 ani State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's Signature Phone (907) 337-61.79 rr In conducting this evaluation, AWWC, I¢b.1tte0oted to prdvide a thorough, conscientious engineering analysis of the system in accordance with ADEC and /O DHHS Guidelines & Regulations. The reported results described 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 soils 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 opo F Coo the evaluator of the system. Satisfactory test results do not guarantee future performance o of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p� system will continue to meet the operational requirements of the ADEC or MOA DHHS. ...;; The content of this report is for the sole benefit of the owner listed above. Any 0 reliance upon or use of this report by any other person or party is not authorized, :.. ,. ��......:... nor will it confer any legal right whatsoever. Q2 .J ffr A. Garness: G. DHHS SIGNATURE k'f Approved for 3 bedrooms Disapproved Conditional approval for Additional Comments 0 E-7953 .... cA- bedrooms, with the following stipulations: Date 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. 1191) Back MOA#21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: TRACT E, CEARK SUBDIVISION Parcel I.D.: 020-441-06 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 10/30/78 Total depth 56' Cased to 53' Casing height (above ground) 24"+ Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test 10/30/78 Static water level Well production 3 9•P•m• WATER SAMPLE RESULTS: AT INSPECTION 11/19/99 <25' Coliform 0 Nitrate 1.89mg/L Other bacteria 0 Date of sample: 11/19/99 / OB RESAMPLE 12/7/99 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 8/26/99 Tank size 4000 Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression (Y/N) NO High water alarm (YIN) YES Date of Pumping NEW Pumper C. ABSORPTION FIELD DATA *DOUBLE CLEANOUTS PRIOR TO TANK. Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System Length Effective absorption Date of adequacy Width Gravel thickness below pipe Fluid depth in absorption field Monitoring Tube present Depression over field (Y/N) For Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate =— e treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' Computer Version Bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES level at" "Pump off' level at* "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 75'+ On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main Public sewer manhole/cleanout N/A _ Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation — 5'+ Property line 5'+ Absorption field N/A Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation n service line Surface water Driveway, parking/vehicle storage area Wells on a F. ENGINEER'S CE itsil TI 1 certify, thatZord t ru aid inspections and review of Municipale ove stems are in conformance with MOA Hi o this date. Engineer's Nam��11JEFFREY A. GARNESS HAA Fee $ Waiver Fee $ Date of Payment Receipt Number . 72-026 (Rev. 3/96)' Computer Verelon Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF I `.-�ALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL F"fiG ECTION`A LIC ff • STREET OCATIO � s r_rLO L - ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 JAN 191979 SINGLE FAMILY ❑ One ❑ Four ❑ Other ((''��( ❑ Two ❑ Five REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERpp E�.I1-d-D 7. WATER SUPPLY DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. >K:L INDIVIDUAL* 1. PROPER TYO NER /a S ❑ COMMUNITY PHONE S 14 IT d;14 r 7d 8. SEWAGE DISPOSAL SYSTEM V INDIVIDUAL/ON-SITE** MAILING ADDRESS 0 ouA /-rt 1%r If system is over two (2) years old an adequacy test is required PROPERTY RESIDENT (If different from a ove) (�/M 0u C..o by this Department. PHONE 2—l'?. ItS 13 `19• G 2. BUYER + y � "o ✓� PHONE MAILING AC�ESOQ� �� i!/- ' 3. LENDING INSTITUTION � / A HONE MAILING ADDRESS �,J K ' W �C/tr[,� �• �/ C • 4. REALTOR/AGENT PHONE '42.69 MAILING ADDR SS ��v s tO6(/_ L ) -'5-- /- TE-* . Irr r A) 1" --2 kJ 5. LEG DESCRIPTION u STREET OCATIO � s 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ,L� Three ❑ Six 7. WATER SUPPLY >K:L INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) C, 8. SEWAGE DISPOSAL SYSTEM V INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) SL THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 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 DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E��—APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED 112 DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) E /0 U I` WP