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HomeMy WebLinkAboutHULL DUNN FREEZE OVER LT 2Hull Dunn Freee Over Lot 2 #020-291-63 SUBMITTAL Crit 9 A')n1ri P ivlunlclpautyorAnchorage 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:/Avww.muni.org/onsite • (907) 343-7904 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSPI31424 PID Number: 020-291-63 ❑ New ❑✓ Upgrade Name: Michail Dunn & Suzan Mullane ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 19230 Villages Scenic Parkway ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade LEGAL DESCRIPTION 3 GPD/SF Ft. Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Hull Dunn Freeze Over 2 FL Ft. original grade Gravel lengthTownship Range Section Haddedove Ft. Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Ft. Total absorption area Number of trenches FL Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 115.0 NIA N/A N/A 78.4 TANK ❑Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer Capacity Surface Water 100+ N/A N/A N/A Anchorage Tank 1000GaI, Material Number of compartments Lot Line 78.6 N/A N/A N/A Steel NA 2 LIFT STATION Foundation 34.4 N/A N/A N/A Manufacturer Capacity Curtain Drain N/A NIA N/A N/A Gal. Remarks Tank replace Only. Pump on level at n. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPEMATERIAL Housetotank Tankto 3034 3034 A+ Home Services drainfleld DrainfieldCOlMT 3034 BENCHMARK (Assumed elevation) 100ft Inspector Pannone Engineering Services Inspechoo dates: Is' 11/13/13 Z� Location and description 3" 4'h Corner of House - Bottom of Trim COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp Conditional Approval: Date OF. At / .... . ....... �`..I5rinnone' I, CE 8149 , Approved l �(l`dg7yp�� Date J 1 Insoection Reno -1-17 dnr. P � 1 3 ����� • SEPTIC AREA (E) E) / LOT 2 _M 1 E) DRAIN FIELD ( W� lol � 11 r m 3 BR A HOUSE (E) 115.0 Iz I NOTES: RECORD DRAWING _► 1 A B T1 35.3 54.7 T2 41.6 60.4 DC 43.4 62.1 � 1 3 ����� • SEPTIC AREA (E) E) / LOT 2 _M 1 E) DRAIN FIELD ( W� lol � 11 r m 3 BR A HOUSE (E) 115.0 Iz I NOTES: RECORD DRAWING _► 1 z o s0 0 0 w0 11 oz o� U S U z a p mz pp 'Elm II NEW 1000g SEPTIC TAI � 1 ' L c� V` N �rt Z c. A 1� 1 COLLAPSED 1000g SEPTIC TANK (E) ABANDONED PER CODE INSTALLED NEW 1000g SEPTIC TANK W/ DCO WELL (E� \ � SS1UN EAS ' EN - - jA SEPTIC AREA (E) Wim_ W� W PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 HULL DUNN FREEZE OVER, LOT 2 MICHAEL DUNN & SUZAN MULLANE 19230 VILLAGES SCENIC PARKWAY ANCHORAGE, AK 99516 *:`49 OF .. j1�, 1/31/2014 1"=50' )" P.I.D. NC n rc. rannone CE 8149 pROFE5510N`� \\_"� PERMIT NO. OSP131424 Sheet 2 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: OSP131424 Tax Code Number: 02029163000 Work Type: Septic Permit Effective Dates: November 07, 2013 to November 07, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: HULL DUNN FREEZE OVER Site Legal Address: HULL DUNN FREEZE OVER LT 2 G:3637 Owner/Address: DUNN MICHAEL A& MULLANE SUZAN T 19230 VILLAGES SCENIC PARKWAY ANCHORAGE AK 995166203 Site Mailing Address: 19230 VILLAGES SCENIC PKWY, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 64083 Total Bedrooms: 3 N Disposal Field Y Septic Tank N Holding Tank N. Privy N Private Well N 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 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 By: Date: Date: ll /3 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 Parcel I.D. 020-291-63 Property owner(s) Michael Dunn & Suzan Mullane Day phone Mailing address 19230 Villages Scenic Parkway, Anchorage, AK 99516 Site address 19230 Villages Scenic Parkway Legal description (Sub'd., Block & Lot) Hull Dunn Freeze Over, Lot 2 Legal description (Township, Range & Section) Lot Size 64,083 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: Waiver Fees: (® all that apply) Date of Payment: Receipt Number: QgIV IC? Receipt Number: Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade Duplex ❑ (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) *,W() — Permit/Rush Fees: Waiver Fees: Date of Payment: I II & 13 Date of Payment: Receipt Number: QgIV IC? Receipt Number: Permit No. QStol3Iya4 Waiver No. Permit App_: :-'.,:c- Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panen¢ak.com November 4, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Hull Dunn Freeze Over, Lot 2 Emergency 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 has collapsed, and is exposing raw sewage to the environment, placing the home out of service. The existing 1000 gallon tank will be abandoned per code. This lot is served by a private well that is over 100' from the septic system. The surrounding lots are also served by private wells that are over 100' from this 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 2 slopes from northeast to southwest at approximately 11% in the area of the tank replacement. The proposed installation will be located in the eastern portion of the lot, in front of the house, and next to the existing septic tank and absorption system. Mailing: P.0, Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-4211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 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 100217, Anchorage, AK 9953.0-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907)272-8218 FAX: (907)272-8211 E) SEPTIC AREA (E) L A N �. t m Im 11� DRAIN FIELD (E) WCC 1 0l V 1 3BR \1 11 COLLAPSED 1000g SEPTIC TANK (E) HOUSE (E)- INSTALL 1000g SEPTIC TANK (P) 1 14.1 W/ DCO DRIVEWAY L WELL (E) 3 jVUN FAS SEPTIC AREA (E) w�_ w_� W NOTES: PANNONE ENG SVC, LLC EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 HULL DUNN FREEZE OVER, LOT 2 MICHAEL DUNN & SUZAN MULLANE 19230 VILLAGES SCENIC PARKWAY PLAN ANCHORAGE, AK 99516 1 1 1 k: 49 rrH Steven • .Pannone PF,•, CE 8149 1/4/2013 1"=50' P.I.D. NO 020-291-63 Sheet 1 OF 1 MUNICIPALITY OF ANCHORAGE (/• �, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION /// 825 L Street • Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM ANDER WELL INSPECTION REPORT NAME RP&rb - C A-7Rc PHONE X77--azo EW OUPGRADE MAILING DRESS (Sox Ll - 5'8(0 LEGAL DESCRIPTION 0 8 TRRc,� I `! is l%I ��>4rJes s D LOCATION - NO. BEDROOMS 3 U Y DISTANCE TO: Well //� Absorption area Dwelling PERMIT NO. _ WZQ ManufacturerR MaterialSz £,f L No. of compartments ,2 wF Liq. capacity in gallons 000 IF HOMEMADE: Inside length Width Liquid depth 60 Y 2 DIST - TO: Well (ling PERMIT NO. Parfufacturer .lienal Zq>kefapacity in gallons DISTANCE TO: Well ^ icaC Foundation Nearer I t line PERMIT NO. U 7 Z W H No. of lines Length oa I Z Total 13h of I Trench witlth /.1 es .>e Distance between Im- Top of tile Av- gr 2 Material bene tile « - Total at lective absorption arRa W Length V Width Depth PERMIT NO. Q F W d Type of cnb Crib diameter Crib depth Total effective absorption are qTANCE TO: Well Building i anon Nearest lot lino J J Class YDo^ Depth Driller Distance to lot line PERMIT NO. /� 4e W 3 DISTANCE TO: Building foundation Sewer line Septic /a V Absorption area(s) OTHER PIPE MATERIALS /� CGS/' ze,n �%Fa✓r Ti C 7h 1%ex� SOI L TEST RATING /� /l0 D S 7`Y INSTALLERis,G' REMARKS .J" 5 APPHOV D DATE LEGAL 72-013 1Rev. 3178) rq1-Ara X t: 1 F'HL JL 1 'T R-1 t-=, "r.4t.:HGF=.HLai E � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PfOTECTION /zy n. 825 'Lr-�'STREET, ANCHORAGE, AK. 99' ( �j f �• -ft 264-4720 yK0 Lo L) L4EL.L FIr4E> 01N I TE S~EL4EFS FPEFSM I T PERMIT NO. C 810484 ) APPLICANT P.ANDEL CAZAC BOX 4-486Awf -�1 �I " 277 3203 LOCATION THE VILLAGES S/D LEGAL LOT 8 TR 14 THE VILLAGES S/D LOT SIZE 40000 SQUARE FEET i TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH -7 1 'gI MAXIMUM 14UMDEP. OF BEDROOMS = 3 SOIL RATING CSO FT/BP.)= 16O `' THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 'LVEF -'-r 4 LEr11GTH= 120 CFS FI k- EZL—E>EF�TH= 2 THE LENGTH DIMENSION IS THE LENGTH CIM FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REOIJ I RCD SEDT I C TFIr4U" 1lDtDE3 GFIILLOr45 PERMIT'APPLICANT.HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE IN_•TALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TI-4OD C c^ > I rJSF-ECT I Or+15 FI FSE FSEQLI I FZM1> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. S MINIMUM DISTANCE BETWEEN) A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE 14ELL TO A PRIVATE SEWER, LIME IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. 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=*EFSM I T EXF=' I FSE GECEM0-EF2 1- I I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOP. ON-SITE SEWERS AND NIELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT RANDEL CAZAC ISSUED BY V4. 0 p p ..*CONSTRUCTION TEST LAB -r 1800 W 48TH AVE. STE. 'C' .� -..:ANCHORAGE, ALASKA 99503 :. 248-1333 PERFORMED FOR gteve Navednrn "•DATE PERFORMED: 4/23/79' LEGAL DESCRIPTION: Lot 8 Block Tract .14 '. Subdivision The Villages THIS FORM.:REPORTS:r : Test ; ,® Visual. Shcs -Examination D Percolation DEPTH SOIL FEET c DESCRIPTION NOTES " Peat 0 Z .1 Brown Silty gravel/ with trac _ — — 5' of sand UjH TTS Z 0 - ` Brown silty gravelly sand" 10' — `Bottom of 'test hole, Bedrock — /oZ - f- .il� ¢ 0 Z UJ (L ) _ — — V) UjH TTS Z 0 avi ivrvi vr. nv"Q.. o.tr'�•- •••�Uy/ . WAS GROUNDWATER ENCOUNTERED " No % *.049TI40 r..... .. ..».... IF YES, WHAT DEPTH LEGEND A c; : Kinney R. Boat ' 3656•E •' ?�' C - Perc zone �j'nrF �,, .• � a S - Sample tokeni 9F ••.,••��•,,.•• a - Frozen zone ,�L "90FESSIM" GENERAL -SITE- SLOPE.' V - Water table READING ._'„DATE GROSS TIME`-..: NET TIME,- 1.7 DEPTH TO :H2O. NET DRAINAGE i 2 4" No water n " n 3.0 b U 3.5 " 4.0 73.5" 3 '-5 PERCOLATIW RATE: 1"/9 min. DRAINAGE REQUIREMENTS i' PROPOSED 'INSTALLATION-,.. ,O SEEPAGE PIT DRAIN;- FIELD.':" 'Cl OTHER'`, COMMENT -k: Bedrock encountered at 10'. 160 square feet drainage area required per bedroom.,.' TEST PERFORMED BY;: David Paul DATA CERTIFIED -BY:_ Kinney R. Baxter- '-- . �.,. ......... ....�..-.. .. �. �.:-•:_,.. -DATE:' 5/28/81 ... , i7GnwtiXC✓ or �C�'�c a �/ y4� �r/ �1sa 4-oI I -a c-l-Y,ridc �J J 6e ccAlt coal ^�fPPc(' o„05 P4 GJ� y.�l _4 ;10' V),t� � -0- t tb NEW UTIL. ESMT. A5 ,\ REPORTED BY CEA. 6-1-81 I` ,20` `0 1 N7g'26-53. E 50 0, % Q \ PROPOSE HOUSE F.F. ELEV 1132 \ :� 1 e o ^ 1 0 LEGEND FND. B.C. MON. V-EPRVF MED z �1 X 30�ANG�oO DRAINAGE gxclus ion Note, 7a 5 Z� 9�r4= f Its is the Eresponsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. PLOT PLAN LdSurveycerlifcation ..sw \ R'eD by 1hnDrartifynatlhor.tt.r --�, OF 44 %I , Gordon Shere� a Associates �� ( �........ �0 • d't'de0, ,°°0'r, ,' b',b,°A,,; �'', ~~5�9+� LondSurveying- Civil Engineering �Ioposrrwre��� kyr 1493 s.�/� Anthorope, A/osto 276-2157 mnotowloporecoana+ 41""'t".... �•'� Sct�/e: 1"-40- Dole: ZJUNE 81 Drown 5.0 aeJmen'pop"arWflvtno-a(��`��1! .. By: �'OVeA" cnodl000lM ' �.S»Codd"Sheret -'�A�»j Grid.•3637 Re: 81-52-5 F.Q: .1031 "aArlopereruaorh m the �. :� r� parole" h poeetim ad that ♦ N '� i thereaaroroodvofyutMty +�aFo',,,�..» �. ,� Lego/ Description: LOT S -THE VILLAGE5 - Iran"MptwtyS Apt crde ��1`;",`�P``� PINE RIDGE 51-1131). V6w%d hereon. ' \| i cj V 91 Ir 10 k� � � i cj V 91 Ir MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include tot, block, subdivision, section, township, range) Location (address or directions)�cJ320 V 16L Kj1C— OGENWc_ VAV ` -)'N / olp PUTTLY- tkw (b) Applicant Name - C - Telephone: Home 2 4. 4 3 Business 2-6-65 -Z-6 Applicant AddressP O LX _ ' Z�� �41)r :f�°� '%rjL*7 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder�j Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent N T n - Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family''+ Multi -Family ❑ Other Number of Bedrooms 3 Individual WellA Community ❑ Public ❑ 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> 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 1+1.84) 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, 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 regulations in effect on the date of this Inspection. r Name of Firm Jj 1 (L�^+ '�'— CNtp' `fir Telephone 11-5-7012B Address Date . ., �OF q� .......... •.-% 0 ! Engineer's Seal i* H •T 00:. o..... .. S .. V• „�, THOA' 0. rISCHEfl ' `OQci •% CE • 6793 • •: ' �� if rr t, a ki4hpdwo 6. DHEP APPROVAL Approved for "f�" `� bedrooms by �7� 4d' 2V—^^ Date /='��g'$�' Approved Disapprovedy Conditional Terms of Conditional Approval Aja CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (OHEP) Issues Health Authority Approval certificates based solely upon the representations 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 requirements. 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. Page 2 of 2 72-MIrve,1 W AYJWGPALW Of ANCHORAGE DEFT. OF WEALTH 6 EPWW0N Vft fAL MTECftON RECEIVED A. WELL DATA W MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (MAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification T ZA VASA If A. B. C, D.E.C. Approved (Y/N) #Jliar Well Log Present (Y/N) Yom- Date Completed M L,T Yield _Z Ci:E'W+ Total Depth 33O Cased to ZO Depth of Grouting Static Water Level als Pump Set At -F3 % ^t - ICasing Height Above Ground Sanitary Seal on Casing (Y/N) Y`3 Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) tJ� Separation Distances from Well: .1 To Septic/Holding Tank on Lot b ;On Adjoining Lots ��) `�— To Nearest Edge of Absorption Field on Lot 1i y ; On Adjoining Lots To Nearest Public Sewer Lined To Nearest Public Sewer Cleanout/Manhole 14.1 A To Nearest Sewer Service Line on Lot / f �— Water Sample Collected by Date tmA Water Sample Test Results a3tAm-,exOK"`( IJC �saLicnF=oR.vw Comments� C�SINCt 1IWM 2 �"M Li'. B. SEPTIC/HOLDING TANK DATA OAR) Date Installed LY Size I CA0 No. of Compartments Standpipes (Y/N) XfM Air -tight Caps (Y/N) �N6 Foundation Cleanou (Y/N) Depression over Tank (Y/N) NE) Date Last Pumped 1 \ IEK- Pumping/Maintenance Contract on File (Y/N) !tA 16- ; for N 4, Holding Tank High -Water Alarm (Y/N) 111�: Temporary Holding Tank Permit (Y/N) IN Separation Distances from Septic/Holding Tank: �` To Water -Supply Well . c To Building Foundation 1 t / To Property Line %0 't' To Disposal Field 5 1 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course I ZyQ3 '!k_ - Comments Page 1 of 2 72.0281111841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 4.310 ��t^y Type of System Design SFitA�nr�Y�}/ Date Installed!:K1,A!.`(� (q 81 Length okField tZo Width of field �N�-NOtN ftil (ASAmY- Z4 Depth f Field Gravel Bed Thickness 2 01 Square Feet of Absorption Area 48 o Standpipes Present (Y/N) 1 Q Depression over Field (Y/N) No Date of Last Adequacy Test Results of Last Adequacy Test =W111&F+4e.�- 5--0 %Z-3 RR M Separation Distance from Absorption Field: F " To Water -Supply Well %ZZ. To Property Line -70 To Building Foundation 49 To Existing or Abandoned System on Lot ��� On Adjoining Lots,.)� rrj— ; t To Water Mai Service Lin JrD '�' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course dC1 t " t7- To Driveway, Parking Area, or Vehicle Storage Area 1 O -17 - Comments Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes ,N) _ Comments Check Permitted Bedroom Rating Dimensions Manhole/Access (Y/N) — "Pump Off" Level at nst HAA Request " Vent (Y/y Cycles during Adequacy Test. Meets MOA IcertifythatIhav ecked,verifiie�edd.^.orconformedtoallMO an HAAguidelines in effecton the date of this inspection. Signed ' �. r`SG4tC4,Date `Z 4 Company t^' " -`- OA No. Receipt No. /0010016 +! Date of Payment � �!,�� OF� A4'414 Amount: $ lam' r'�Q,� ''• S ♦ Engineer's Seal �0) '.� i* , 9 �JTN ..... .... �.. .la:... M Page 2 of 2 J Torn A. FISCHFx �� •, CE • 6793 �} i 72-016 I n, BCI ''V/Fire' •.. ..••: C�QCY 6,. -. L. i RECEIVED INSPECTION APPOINTMENTS TIME /�wk TIME TIME DATE ❑ One ❑ Four ❑ Other DATE DATE ❑ MULTIPLE FAMILY Ci3'Three ❑ Six 7. WATER SUPPLY CU INSPECTOR ' ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM 44, C O'INDIVIDUAL/ON-SITE" DEPT. OF N`_T.LTH 8 MUNICIPALITY OF ANCHORAGE �IIROWdENTAL KOTECTION \1 DEPARTMENT OF HEALTH ® ENVIRONMENTAL PROTEC7`fON 026 L Slreat - Arralroraw, Alaska 99WI • SEP 1 0 1981 ENVIRONMENTAL SANITATION DIVISION Telephom 284.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not M Processed. Please allow ten 110) days for processing. 1. PROPERTY OWNER PHONE d (azczc 3g6_zV 9 MAILING ADDRESS - SCS 95� PROPERTY RESIDENT 111 different from above) PHONE /s, ko 2. BUYER PHONE 1 1� MAILING ADDRESS 3. LENDING INSTITUTION PHONE S 0. 411C t r MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 0i _(j nC.� STREET LOCAT N l;llu� gee r )AA /�wk 5. TY►E OF RES CE NU BER OF BEDROOMS (`SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Ci3'Three ❑ Six 7. WATER SUPPLY E_' 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.) B. SEWAGE DISPOSAL SYSTEM O'INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 (Rev. 6/79) e, ,- THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE -B�'SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVE 3. SEWAGE DISPOSAL SYSTEM LJIIVDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑SepticTankor ❑Holding Tank Size: J u aD If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER. .. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line S. COMMENTS �,APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72010 (Rev. 6/79)