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HomeMy WebLinkAboutMORRIS LT 30AI \RCv uuluzl 1 O) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 201424 PID Number: 051 105 30 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name GERLACH ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address MORRIS LOT 30 A ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MORRIS LOT 30A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well +100 — _ _ _ TANK IN Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water +100 _ _ Material Number of compartments Lot Line +5 - - NA POLY 2 Foundation+� _ _ LIFT STATION Manufacturer Capacity Remarks Tank Only. Tank Insulated. - _ Gal. The tank is not within 5 -feet of a deck post Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield RICHARD PERSON Drainfield EXISTING Co/MT3034 Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation)100 ft Inspection 1st 10/18/20 10/19/20 Location and description 2�c BOTTOM STEP OF DECK aro 4"' ON-SITE WATER AND WASTEWATER SECTION APPROVAL4/1/22 Engineer's Stamp �� A`gSll Conditional Approval: Date � '�� ��+� i* •49 • H �.. ... ....... •� Septic System Approved S Date 1 Z 'Le z 7 r�11• CHARLES G BALZARIHI r��s CE -13854 ,t TF�Fo p • • • • P1 r 11 Note: this approval does not include well permit requirements. ROFESSI�N \RCv uuluzl 1 O) OF i : •49 TH •. CHARLES G BALZARINI . ��� ���/•• CE -13854 .•�cc`�® )T 30B MORRIS LOT 30A�� `��Fp' • .aisiizz, •',�2 ��lF�pROfESSIONP �lm Qi I I 3—BEDROOM HOME END OF TRENCHES TH-1 NEW 1250 GAL POLY TANK WITH INSULATED RISER AT FIRST COMPARTMENT APPROX. DIVERTER T15N R1W SEC 9 LT 3 WELL/SEPTIC +200' FROM THIS PROJECT 1' CONTOURS PREVAILING SLOPE IS DOWN TO THE WEST DRIVEWAY LEGEND \ o CLEANOUT s MONITOR TUBE 12' UTILITY EASEMENT ® TEST HOLE DI AKI (`AI C BM:+100.0' BOTTOM STEP FOR DECK SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. 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H N �1N3W3nF/d d0 3`J03 « vv c a) o ✓. : a Z Lu LL ai -- --- - -- u o U rn a i C N @ WL6 u, E a ^V'I C7 v) I •iZE \ Hwy L/17�1 lV% C7 N L+i 4 MUNICIPALITY OFANCHORAGE On -Site Water & Wastewater Program poBox 1yoson 1rOuElmore Road Anchorage, Alaska oys1y'ssnu Phone: no* Fax: (So7)a43-7eo7 On -Site Wastewater Disposal System Permm Permit Number: OSP211427 Work Type: Septic Upgrade Tex Code Number: 05110530000 Site Legal Address: MORRIS LT 304 G:1358 Site Mailing Address: 21113BOWERY LN, Chugiek Owner: GERLACHLIVING TRUST Design Engineer: 8ARNESSENGINEERING GROUP LTD This permit iefor the construction of: RI Disposal Field 2 Septic Tank [] Holding Tank 0 Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 10/8/2021 1U/8/2O22 []Private Well OWater Storage All construction shall boinaccordance with: 1 The attached approved design. l All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska VVaetevvotnr Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC8O) 3 The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.85.Provide notification bycalling (Q07)343'7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received B Issued By: � Date: 0 Date: _101617- 4 n Develo met Services Department p ='�) 3 Development P Phone: 907-3-�907-343-7904On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-105-30 Property owner(s) ROBERT GERLACH Mailing address 21113 BOWERY LANE *CHUGIAK, AK Site address 21113 BOWERY LANE *CHUGIAK, AK Day phone 830-8553 Legal description (Sub'd., Block & Lot) MORRIS; LOT 30A Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms *4 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:Sq Date of Payment: Receipt Number: D�162 y Permit No. OS P2 I 1 y 27 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormslClient FormsTermit Application.doc "HOUSE IS CURRENTLY 3 BEDROOMS APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Q Upgrade ❑ Duplex (D) E] Holding Tank ❑ Renewal X Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:Sq Date of Payment: Receipt Number: D�162 y Permit No. OS P2 I 1 y 27 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormslClient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211427, Deb Wockenfuss, 10/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211427, Deb Wockenfuss, 10/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211427, Deb Wockenfuss, 10/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211427, Deb Wockenfuss, 10/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211427, Deb Wockenfuss, 10/08/21 a) m c o CD m a <' W m 0- a w N-�D � /A p O w cn -i * m t� a � -o co m m a �' (- cn��D�o C) N -0 con cQ m m (D a � CTD rt o r x n N -o, 3 O a w N-�D � /A p O w cn -i * m t� a � -o co m m a �' (- cn��D�o C) N -0 con cQ 3 o a � CTD rt o r x n 0 -o, 3 v �.a3 m CO o o mom v, C)0=3 < o m o con �, _0 � 3 o m m o --:C cn o -u — —• vv 0-0 07 o m' Q v -* Om m o o m O __ m a m `< p z C T v o m OC -U v m M m �;o ni= m m- m! "' o o W 3 C ca m �' ca D z 3 w o m �-0 (D � Q IClCD �i3 m o CD m _� �' r- D a 3 � cao m< (n co m m -0 m � m a o mom -gym• -,•00 a -* o can CD D CL a a ? 1n C- : 0 3 � � a m m 0 cD 3 o -0 -0 : n C7 = con u' m _ o O -CD cn ao om0o;-o0= 3 m0 0 m _r < to O m U7 N c m 0 m m D cao 0 0 a -0-0 - =ti a 0 z o 0 =~ -o �. m Q o -'' m CD X m a a o' m in m z 0 0 � -0 (� 2 m N m .o N — D C co � m cn C -t C � W cQ N j� (� 0- m - o �' n m ZY n' W p0 Zr ccnai0'C a n° 0 O CD CD cn cn -• a � -m ° cr rna �'0 3 17 0 �] r cQ cn (n -0 m c o, m y ,, Z m cD CL ° m < l< v -o o' D: COD m ❑ cn D to 300 m �- �o�D:;� z 74 m r y m c Z) a o < n,0 0 o� 0 --4:5 _ 0 < z 0 �o Ci n Cl) r cnmm_0 — 0- m �� N m m.-0 m � C O ��o:v c° °o o X 30= -omm-,Q oo'o0'm. 0 _am�m D a ov oocn;;z;� co cn 0�0 ° o cn o- = cp ; =r �� m ❑ (� c�i �0 o m m < ` CD ,mho � (C)� =r aim M o U m m;�, m om(O N CD = — 0 -0 m o V C 0 (a. o �. — m ;u0 � CD o' i 0- ❑ a�oo Cl) m Z) ��cn;cn -I r m x m 4 m°�� -0 0 O cn � rn O C W: C" < m rt m O o .t CD o rt o C) o 4j °� D m CD <' -.,° 0 ° m aiv0 DI0 C4�:,00 � om UU m o m v w O M.0 CO n m C (a m ° cn m c=0 cn 0- o U' m .m 3 .0 — O 0 fn o m N 0 1m ❑ N -n CD oQ CD o < o �3� CD cn cQ m o D m mv,o m-0 v CD 3 i(n 3 CD:v L7 0 0 o CD m W CoCD N NA N N cri O O � /A n S CD N D D N T C t� 0 (n z_ C ;x m n 5° 8 * -0 CT a � CTD rt r�-h CD _ C77 o o CD r v �0 m O .. N "n a o .11 C o `°�o* D cn 0 Wom z m � o --:C cn g -, O o ;u -not D 4• CD X Q CD c� 0 m T v A CD W 3 v `D V MN I 4 fes`A T O a • - • RA - --A oh�_ Development Services Department .E Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 � a ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-105-30 Property owner(s) GERLACH Mailing address Site address 21113 BOWERY LN Legal description (Sub'd., Block & Lot) MORRIS LOT 30A Legal description (Township, Range & Section) Lot Size 46,335 Sq. Ft. Number of Bedrooms 4 Day phone APPLICATION IS FOR: (® all that apply) Private Well Absorption Field ® co* I Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) 0 ( Upgrade EDw/wo ADU) Renewal ElDuplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) E V THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: '# d r� O C00 � I b - `1i Waiver Fees: Date of Payment: Date of Payment: Receipt Number: 013070 Receipt Number: Permit No. O S F laO 1`4 a `` Waiver No. AJA f 370 0g2ct5.0 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System Modification for Morris Lot 30A Dear Reviewer, In fall of 2020, the septic tank was replaced at the above referenced property. We are requesting a change order to the permit to install a new drainfield to replace the aging drainfield installed on the neigbor's property. The lot is relatively flat, sloping to the west. Included with this request is as -built survey, site plan, calculations, and soils log. The installation of this drainfield will not impact nearby properties. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(a-)gmail. com with any questions or concerns. Sincerely, n'% Charles Balzarini, PEAL40AW1 7/10/21 j CHARLES G BALZARKI / 63'. CE 13854 .•�c`�A-1` -.. 1 ROFESS00\- Minicipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPUANC OSP201424, Deb Wockenfuss, 10/1& 5CIT"U BA Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System Modification for Morris Lot 30A Dear Reviewer, The above referenced property is currently served by a 4 bedroom septic system installed in 1980s. The Tank has failed and is need of immediate replacement. We are proposing that the existing tank be replaced with a new 1250 gallon moa approved septic tank. As shown on the plan, the tank will be greater than 10' from the house foundation. The tank shall be covered with a minimum of 2" moa approved insulation and 3' of cover or a minimum of 4' of cover without insulation. The repair shall be performed by a moa certified installer in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Records show an old well on the lot near the home. We did not locate any signs of the old well. The owner wishes to replace the drainfield which is on the neighboring lot but will wait until next year. A testhole will be excavated as part of the tank installation project. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(a_gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE .® .� - • �� 10/10/20 ��AWK • CHARLES G BALZARKI GE -13854 �1��F0 pROFES510Na�� NOTE: INSTALL ALL COMPONENTS IN ACCORDANCE WITH/MUNICIPAL CODE AND MANUFACTURER'S RECOMMENDATIONS. Z \ T15N RTW SEC 9 LT 29B / WELL/SEPTIC +200' FROM THIS PROJECT 8 0 SPLITTER 6' OFFSET O MORRIS LOT 30B NEIGBORING SEPTIC O END OF TRENCHES APPROX. LOCATION OF SX110' DRAINFIELD Co 14-1 ®�� c� o� A��s��� ' law 49TH.. .H r CHARLES G BALZARIf�f � •• CE -13854 ••`��� � ���F�pROFESS��NP P MORRIS LOT 30A 3 -BEDROOM HOME DUAL CO'S 1 FOR OLD NEW 1250 GAL POLY FIELD TANK WITH INSULATED RISER AT FIRST COMPARTMENT APPROX. (ALREADY INSTALLED) EXISTING DIVERTER INVERT AT 5' BGS I EXISTING DUAL CLEANOUTS, CAPPED END OF PIPE. RE -INSTALL TH-1 WITHIN 5' OF TANK SYSTEM 3' MAX EX DEPTH SET GRADES TO VERIFY GRAVITY FLOW PRIOR TO CONSTRUCTION DRIVEWAY 12' UTILITY EASEMENT i I 20' ROW EASEMENT SEPARA11ON DISTANCE NOTES: _ THE PROPOSED SEPTIC TANK IS GREATER THAN: 100' FROM THE ON-SITE WELL 100' FROM ANY NEIGHBORING WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER SCALE: 1" = 40' 10' TO ANY PROPERTY LINE OR FOUNDA11ON T15N RTW SEC 9 LT 3 WELL/SEPTIC +200' FROM THIS PROJECT 1' CONTOURS PREVAILING SLOPE IS DOWN TO THE WEST C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: MORRIS LOT 30A OWNER: GERLACH DATE: 10/9/201 REV: DRAWN: CB REF: SITE PLAN CO 7""- C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations Residence: Montgomery Lot 3 RESIDENCE/LOT INFO number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS Calc By: CGB Date: 10/15/2020 OF.," CHARLES G BALZARINI'' CE13854�ti PROFESS'tQ��� Performed For: GERLACH Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Soils Log - Percolation Test Legal Description: MORRIS LOT 30A 9-1 1 BOH, HEAVY SEEP 14- 15- 16- 17- 18- 19- 20 - ,; •NGINEER' EA q?' :9 *; 49 TH CHARLES G BALZARINI 0 CE -13854 �`���� ����� pROFESSIONP�'.a Date Performed: 10/19/20 Township, Range, Section: WAS GROUND WATER ENCOUNTERED? YES S IF YES, AT WHAT DEPTH? 7.2 L Depth to Water After P P Monitoring? 7,0 E Date: 10/27/20 READING Depth � GROSS TIME N ET TI ME DEPTH TO WATER NET DROP 1 (Feet) 3:23 0.000 TOPSOIL 0.0 2 10/22/2020 2- 0:10 4.125 3- 4_1 3 4 - 3:34 - _ 0.0001 _- SW 5- 10/22/2020' SAND WITH GRAVEL AND 0:10' 4.0631 COBBLES 6- 5 10/22/2020.:..___,....... 7- 0.000,,w�,...�..._..��.n.. 8- 6 10/22/2020 9-1 1 BOH, HEAVY SEEP 14- 15- 16- 17- 18- 19- 20 - ,; •NGINEER' EA q?' :9 *; 49 TH CHARLES G BALZARINI 0 CE -13854 �`���� ����� pROFESSIONP�'.a Date Performed: 10/19/20 Township, Range, Section: WAS GROUND WATER ENCOUNTERED? YES S IF YES, AT WHAT DEPTH? 7.2 L Depth to Water After P P Monitoring? 7,0 E Date: 10/27/20 READING DATE � GROSS TIME N ET TI ME DEPTH TO WATER NET DROP 1 10/22/2020 3:23 0.000 0.0 2 10/22/2020 _-3:33 0:10 4.125 4_1 3 10/22/2020 3:34 - _ 0.0001 _- _ 0.0 4 ...�..-- 10/22/2020' 3:44 0:10' 4.0631 4.1 5 10/22/2020.:..___,....... 3:45 0.000,,w�,...�..._..��.n.. 0.0 6 10/22/2020 3:55 0:10 4.063 4.1 7 10/22/2020 3:56 0.000 0.0 8 10/22/2020 4:06 0:10 4.125 4.1 PERCOLATION RATE 2.4 (minutes/inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 3 FT AND 5 FT COMMENTS PERFORMED IN ACCORDANCE WITH MOA REQUIREMENTS PERFORMED BY: C&M ENGINEERING I CHARLES BALZARINI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 07/01/21 O Ln 3..cc,c0000s_. 1 rn y r EE 10 a H ._•« —,. >: O U ` .0 L 0,93, x a@ O > Og pN I I 'ZZ L� moau6 C14E a N °w N L'006 L0 @ 3 w faoQa v v e-i cil 9.06 Cl) ' p w Z c Q_ \ N M. U OO w O a� m W ( N cn cu I I Z'94 o \ QH j Q 0 / N - w @ -0V \ 'O N O @ a) \ / 3:N- _ rj J 76@ .c N (V O co Ca)C bo ,n > .0 @ rn In 01 N O 0 ?i w to -C Ol ° CL 0 fu ai w @Em`s � � a' �o O £6£ 6.69 moo., N (Vm muZ�a y E Q� co Cl) ? c m U N y a) > f— of z _ ° ° @ ra v J C14169 O �°=u _Q = @ W x _x 0'89 °_° d@° W° O LI) v v --- 3 L Q �m to Q� o a, O QO h Z O v ::jY w 0 S. v� *= Cal h a ` �'' i i- C) a) �a NNQ Co 70 o E o Q c `��? 41 I I + oTC7 w' 0 0 ows c i •6b 2 =00 W v u I m` p c o ° m 'D o Tin m y .� ° N ` Q N >' O O OL L I I OMS O ot1N �;. c m Lwa Zpmu m v E Zo (7 I N (��m oaai I > t v oma tiauv75 m 4. a' v O orifi' U I I oc Q u v nZ c=myo h O O i X03 -� i Cl) J HCl) m Y cD c O m�nm� i—$.�axiw Q _I _ ti �rn3 CS -J N * i M< N LL U o) ,n @ c- vi ( I I O Cfl v a `t ~ E Q6 p d I N 0-1 k El@o-ca r- 0 co Ln cli N ro —h+,o —nHo —nno — 1WS3 381,ZL .++o —nHo —n„o no —nno O aj N ul Q' . ZQ• �J W LL p 1Ws3 M o-a,OZ I : �' " z ®' _ x O �c a� o iu x— x 06''96 M„00.60 oOON x `m �' y aN Q � � z� W! w X 1N31N3AHcl30 3,90-9 m o o _ c� LL C) M o '�jto zo n w l7 cn mwuE� X111 .REG`�� y r a) Fes- w¢ Q ti PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930339 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:BAKER MORRIS & LORETTA OWNER ADDRESS:RR 2, BOX 8 AVE FRANKSTON, TEXAS 75763 PARCEL ID:05110511 LEGAL DESCRIPTION: T15N R1W SEC 9 LT 30 DATE ISSUED: 9/03/93 EXPIRATION DATE: 9/03/94 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WELL WILL BE DRILLED ON SOUTH 1/2 OF LOT. WELL. RECEIVED BY: ISSUED BY: ABANDON EXISTING 0 0 0 0 0 © 0 GREAL.,:R ANCHORAGE AREA BOR~.,~'GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM r~ ~ Z~,<. LEGAL DESCRIPT,ON AurYo ~,. ? T/,~'~ LOCATION / SEPTIC TANK: DISTANCE ?; FROM WELL INSIDE LENGTH f/¢~-~ //' ~' . / NUMBER OF _ COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT~/d:~(~ALLONS. TILE DRAIN FIELD: · D~STANCE FROM WELL h FOUNDAT,ON 2, -5 NUMBER OF LINES K DISTANCE BETWEEN LINES ABSORPTION AREA 3 ¢~'* SQ. FT. LENGTHOF EACH L'NE DEPTH: TOTAL LENGTH NEAREST LOT LINE ,C~ (..) OF LINES TRENCH . TOTAL EFFECTIVE ,/ DEPTH OF FILTER TOP OF TILE TO FINISH GRADE '~L~' MATERIAL BENEATH TILE IN. ABOVE TILE .~/ IN. WELL: CONSTRUCTION DEPTH DISTANCE FROM: BUILDING ~/~/,~-, .-NEAREST FOUNDATION , LOT LINE NEAREST SEWER LINE__ TANK , SYSTEM CESSPOOl APPROVED ~ .~'~'~ . OTHER SOURCES DISAPPROVED REMARKS DISTANCES: -- INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: Form EQ-O$2 DIAGRAM OF SYSTEM DATE PERHIT NO. APF'L [ C:~NT LCICRT I ON [_EGRL MORRIS B JHEF.. -r LANE L]:R SEC: ?800 [.EBARR LOT _ I~:E T'-/F'E OF SOIL AE,_UF..ETILN =,'r_TEH IS: [RRINFIELD MR::-:: I MUM NUMBER OF BEDROOMS = 4 '90000 SL.-.!URRE FEET _~ FT,-E,R ~ .... ¢;F~IL RATING (SQ /,--,~- o=' THE REQUIRE[:, SIZE OF THE '=-:OIL HE,=,URFTION .:~-TEM IS: THE LENGTH DIMENSION IS THE LENG'rH (IN FEET) oF THE TRENCH OR DRRINFtELD, THE DEPTH OF R TRENCH OR PIT IS ]'HE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TRENCH WIDTH FOR DRAINFIELDS IS 3: FEET. THE GRAVEL DEPTH IS THE MINIMLIM DEPTH OF GRAVEL BETWEEN THE OUTFRL. L PIPE AND THE BOTTOM OF THE E',:.::CRVRTION (IN FEET). BACKFILLING OF RN'¢ S'¢STEM WITHOUT FINAL INSPECTION AND APPROVAL B'¢ THIS DEPARTMENT WILL BE SUB..IECT TO PROSEE:UT~ON. MINIMUM DISTANCE BETWEEN R WELL AND RN'¢ ON-SITE SEWAGE DISPOSAL S~.'STEM IS · 00 FEET FOR R PRIVATE NELL OR 20~ FEET FOR R PUBLIC NELL SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, F'ERf-1 I ]- %-'AL I C. FIDR OP-~E "¢ERF: FE~CI~-I I S;)LE;EJE] I CERTIFV THAT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS S:;ET FORTH 8'r' THE MUNICIPRLIT9 OF 8NCHORAGE. 2: I WILL INSTALL THE S'¢STEM IN ACCORDANCE WITH THE CODES. S: I UNDERSTAND THAT THE ON-SITE SEWER S'¢STEM MB~" REf::!UIF'.E ENLARGEMENT IF:' THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT MORR I =, BAKER I '_:,SUED'~'~~- -~-~-~' ' ' [:'RTE--~--~--7--~-''~ ' GReA~.__~R ANCHORAge ARea Bor~Jgh PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT TYPE AND SiZE OF FACILITY TO BE SERVED SOIL TEST RESULTS COMPLETION DATE ANTICIPATED // NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY:~=~ ~WILL SUBJECT TO PROSECUTION, FOUNDATION TO SEEPAGE PIT 11111171~31U WALL MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK SEPTIC TANK TO SEEPAGE SEPTIC TANK , SEEPAGE PI WELL TO SEPTIC TANK : AG P, DRA,H E,EL IT k IK TO RIV'R' LAKE' STREAM'o~ ~ ,~o~ ,N~O ~N~ ~ ~,~ ~/ 0~ ~ O~ FEET T U TER C T IR IRTI MOSLE GRAVEl- BACKFILL CONFORM TO BO~. CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE FORM NO, E(;~-016 GAAB-HO- I GRr'''tER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY / NUMBER OF ,-~ MATERIAL -->'~'-~---'~----' COMPARTMENTS ,~',,~--~'--/~-- -.~'-"~---~ ~ /~QUID INSIDE WIDTH ~ DEPTH GALLONS. INSIDE LENGTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PIT,~/~E DIAMETER ql~ winTH LENGTH , DEPTH LINING/~AL LL NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA OEPTH: TOP OF TILE TO FINISH GRADE //'~' ~" FOUNDAi'ION DISTANCE BETWEEN LINES '~' ~' '"~ ~'j' TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE ,r ~ DEPTH OF FILTER MAJERIAL BENEATH TILE NEAREST LOT LINE /~:~ /~'~' oFTOTALLINEsLENGTH/'~"'~ IN. IOTAL EF:FECIIYE IN. ABOVE TILE WELL: LOT LINE TypE:~'/,/-,~-.~'~:~ DEPTH ~f~->~" NEAREST ,----' SEPTIC ,,/~ '" ~' SEWER LINE , TANK DISTANCE FROM , BUILDING FOUNDATION. SYSTEM ,'//'--~ WATER SAMPLE NEAREST OTHER , CESSPOOl ~ , SOURCES DIAGRAM OF SYSTEM DISTANCES: HEAL[H AUIHORIIY GAAB.iID-2 )ROUGH GREATEB tNCHORAGE AREA k HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SE~lC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH 33~-~ ~b MAILING ADDRESS 7~<~3 ~T?~,~../. PHONE NO. LOCATION OF INSTALLATION "~,3~-~ L- a~/~__ SEEPAGE PiT / , DRAIN FIELD TO BE INSTALLED BY ~ ) ~- · OTHER PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ~ ~. , -'~ ~!~L~. ~ , PERMIT TO INSTALL A AS DESCR,,EO ,ELOW. S,ZE OF.. 27 ,E SERVEO · SEPTIC TANK SIZE /-'~' ~ TYPE ~SEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: ,,, [ ce~Qt'y that ! am t'am~tlar with the requ~eme~ts of Grea~er A~chor~e above des~bed system is ~ accordance with ~id ~od~. ~ DATE ~ APPLICANTS SIGNATURE HEALTH DEPARTMENT CASE ~{ 327 EAGLE STREET ~/ ANCHORAGE, ALASKA 99501 rformed For ~rr,'.% ~.:,b,~ Date Performed t& '-~ Legal Description: Lock, lock a~civlsion ~.~ q ~S~ ~(~ This Form Reports a: Sozls Log .. ~ .Pemcola~ion Tes: Depth Feet Soil Characteristics Was Ground Watem Encountered? If Yes, At What Depth ~'.-. Location Sketch Reading Date Gross Time Net Time Depth To H20 Net Drop e~col~'l:ion {ate 1"/ Minuta ' P~Ol~sed Installation: Seepage Pit Drain Field Depth Of Inlet ,~ C q, Depth To Bottom Of P~t O~ T~ench COMMENTS:.. Test Performed B~=. f),~r,r, ~ i Data Certmed ' ''~"' : "r ':r'', : '' ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Dill'sion of Environme~ital-S~r~ices "" :' '::' :':':"!' ; '~ On-Site Services section ' '- ,.. ,'~ ,, '-, : P.O. Box 196650 Anchorage!Alaska ,,_99519-6650 :-. !'%:".:'.'. i .-' . . . ' ' ... - 343-4744 -: -'~ . , .,-..:,.:: - ·. .. ':, . .., ; .... ;. '. ....... , ' '-';~'" -"" ' ."' ' ' CERTIFICATE OF HE~TH~UYH'ORiTY- - - - '. ?-:" -: '-- i - ' APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION ':' ' '; :' r ' '" ' ' ' . Complete legal description Location (,site aaaress ur uiIfCUl, lUllOl , ~ ~;;~e~ewn~?:~'~:-*~' .. __~.. ---__~ ~-~ ~ ~ Day phone ~'~/--- .~ .... · ,, ..,.. ,- ,z~:.. ~ · ~. -,~ . Day phone ... Le~alna,¢Q~H~y ....... -.;Ma ng~aUSress,''' '"' Address . . Unless otherwise requested, HAA will be held for p~ckup.. . ~ ~'o .UUSEROFSE ROOMS: ¢ . 3 TYPE OF WATER SUPPLY: · -¢~' · ndvdua wet - ~ ' ~, ~ .: ..... :' Community well ' : ' - '¢_-,, ' .... Pubhcwater .- -, , ' NOfE. If community well system, prOvide' ..... written:? .-_c°nfirmati°h. :-fr0m State · . . .. _ - .. . ~ . -;~. . '4.' TY'~FWASTEWATERD'ISP0SAL: ~ '::' '"' ' ' ' ':~-'-~{~ · ' ::'.,': ;' ~ '-;;'.-.;.-:,,.~. ..... g..' .-., '. ,.??- ':'.- 7 '?-/;,-:- ,'., "..'. .-;:' ' 7-'"' '-;'~'- - :'/' ' ' STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my 'investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from'my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. . Name of Firrn /_~,¢ ~..~z.~¢~ '"'-'"- ' DHHS SIGNATURE '-~ Approved for ~----Od'¢'- ~'-['~ bedrooms.. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments y:.:. The MunicipaJity 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 ~s issued. The Municipality of Anchorage is not responsible for errors.or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~i21 ~ Municipality of Anchorage ((~-~L~'~['i"~--,)I DEPARTMENT OF HEALTH & HUMAN SERVICES ~~ Environmental Services Division 825 L Street, Room 502 .Anchorage, Alaska 99501 · (907) 343-474~ Health Authority Appr0val Checklist A. WELL DATA Well type .z;~,~l Log present (Y/N) ~/---~'~ Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed /~/~.//CJ Cased to z/Z) "/"- '~' Casing height (above ground) Sanitary seal (Y/N) ,Y" Wires properly protected (Y/N) Y' FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~- Nitrate ~' °/-/ Other bacteria Date of sample: ~,'~-~, .~'~ ~ c/~.7 Collected by: B[ SEPTIC/HOLDING TANK DATA Dateinstalled~.~v /~'~ Tanksize /-~-~"'~z~NumberofCompartments .~ Cleanou~/N) Foundation cleanout ~/N) ~ Depression (Y/N) ~ High water alarm (Y/N) Date of PumPing ':~ ~:~:~'~:q ~ Pumper ~. C. ABsoRPTION,~IELD DATA~ ' D~te'j~st~oed ~Y" ~ ;~ Soil rating (g.p.d./ff~ or ff~/bdrm) ~ System ~pe Leith ......... . ' 'Width ~' · Gravel thickness below pipe ~, ~/~i Total depth Effecfiveabsotption' ar~a..~' , '~ ~ ~onitoring Tube present ~/N) ~ Depression over field (WN) ~ g~"~ Date of adequac~ fe~t'~ ~ /~ Results (Pass/Fail) / For ~ bedrooms /' Fluid depth in absorption field before test (in.); ~ Immediately after ~/~gal. water added (in.): ~ ~'~. Fluid depth ~ ' ~ (ins) Minutes later: ~ Absorption rate = ~ ~ ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N)' ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot /~%¢ Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation .2, .~-.,~ j- Property line .,~ ~'-'~.~ Absorption field Water main/service line ,;Z,5-/~,~YSurface wateddrainage /~' ¢ ~,'ZWells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ,~-.~ z~ Building foundation -~¢,,~-"~',/' Water main/service line Sun"ace water "~ ,~ ~ ./: Z:-. Driveway. parking/vehicle storage area Curtain drain /--J~',o~-~ ,~.~,,~,.,~xJ z-~., z~,~-,,--- Wells on adjacent lots -/'~ HAA Fee $_ ~"~' ~ ENGINEER'S CERTIFICATION ,certify that I have determhled thru field inspections and revie, o, Municipalrecords~¢,~..~.~CCrrnS are in conformance with MOA HAl ~'de~ hi effecton this date. Signature Engineer's Na ~ l ~ '~ '." ~ i~--'/"~,~'.'~.?~A, Date of Payment C.~///~?//~ ~:~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 NAA # GENERAL INFORMATION Complete legal description Location (site address or directions) q yo_ 2 Property owner Mailing address Lending agency Day phone Day phone- Mailing address Agent ~;~::)~r-~,g,3--,a ,~-,~d., .~rr,~ ~'7~--,-~-~ Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual well A' Community well Public water NOTE: ]f community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 7- Holding tank Community on-site .. ,-Public sewer " : '-' ' NOTE: If community wastewater system, provide written confirmation from State ADEC, attesting to the legality and status of system. ..... ::'' r~ ": : ''' --' 72-025 [Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows ~hat 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. ~ further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm David R. Dayton P.E. Phone 20210 Donalar Address Chua|ak. AIa~I~:~ Date DHHS SIGNATURE Approved for DisaPproved. Conditional approval for bedrooms ...... bedrooms, with the following stipulations: Additional Comments ~ "' 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, 1/91) Back MOA#21 ,. Legal Description: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~J-j ~ ~/~ Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number /~/~/9 ~ Driller Date completed ~ / Cased to c= ~ Casing height · y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION /~ g.p.m. ~, o g.p.m. SEPARATION DISTANCES FROM WELL TO: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: ~o / z-?~'~ Nitrate c:~, ~r/~ Other bacteria Collected by: ~-~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~ z_~-~ Compartments 7_. Foundation cleanout (Y/N) Y' Depression (Y/N) · ~' ~/r-- Alarm tested (Y/N) i~/~..,I~/~ Pumper ~,~-~, ~r~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~ ~ To property line Surface water/drainage On adjacent lots ~ ~ c~ -~- Foundation Absorption field ! ~-- Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)° Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length .//o ' Total absorption area Date of adequacy test Width Soil rating (GPD/FF) ..,g '-/- Gravel thickness ~ ~,p ~- ~'?- Cleanout present (Y/N) / o / ~._.~-/<? f/ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) System type ~'-,~,~u~-oz ~, ~'~ Total depth ,~ ~/ Depression over field (Y/N) /~,"h'5~ for ~ ~ After test ~ If yes. g~e date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~..~) o On adjacent lots To building foundation On adjacent lots Surface water Curtain drain Property line To existing or abandoned system on lot Cutbank ~ /g- Water main/service line Driveway. parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidel/nes in effect on the ~t~,of this inspection. David R. Dayton P.E, ,', 2O21O Signature Chu~iak, Alaslra 99567 Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number EAGLE RIVER AREA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274~4561 Date Received September 10, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Conv. Peoples BAnk and Trust Pouch 7007 99510 Morris $ & Loretta A. Baker Star Route Box 894 Chugiak, Phone: 279-7511 x 42 Phone: 752-2663 (Her) 99567 3. Legal Description: Lot 30 T15N R1W Section 4. Location: NHN Bowery Drive 5. Type of facility to be inspected Single Family 6. Well Data: individual No. of bedrooms 2-3 proposed A. Type C. Construction B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed J~< C. Septic Tank: 1. D. Seepage Pit: 1. On-site system /~ B. Installer Size /~2~z/ 2. Manufacturer~?~,-/ Absorption Area ~ ~ ~ 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area/O ~/ , Sewer Lines ~', Nearest lot line ~)~ o , Other contamination B. Foundation to septic tank ~ ~ , Absorption area C. Absorption area to nearest lot line ~ o EQ-034 (1/74) Page 1 of two pages P~e 2 of two' pages - Reqq.~t for Approval of Individual S~.r & Water Facilities ~-~Legal Description Lot 30 T15N R1W Comments Approved ~.~=-- : -_~-.~ - Disapproved .~ Date /~l~~A~alid for one year from date signed ~/~reater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 -- 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICI?ALIT¥ OF >,NCHORAQI~. DEPT, OF HI~ALTH & Ir:NVIRONMENTAL PROT~ CTION,: SEP I 0 1976 RECEIVED 1. Type of Inspection: 2. Property Owner: CMRO VA Morris R. & Loretta A. Baker FHA CONV XX Mailing Address: 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: Star Route, Box 894~ Chugiak~ AK 99567 Morris R. &Loretta A. Baker Day Phone 752-2663 (Mrs.) 752-4563 (Mrs.) 752-2428 (Mr.) Same as above Peoples Bank and Trust Day Phone Same as above Pouch 7007, Anchorage, AK Phone 99510 Builder - Bill Martin 279-7511 x - 42 Sound Construction - Box 893 Eagle River, AK 99577 Phone 694-9863 6. Legal Description: Location: Lot 30, T15N~ RIW~ Seward Meridian NHN Bowery Drive1 Chugiak~ AK 99567 Single family residence will be Type of Facility to be inspected: constructed on. above property Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served Individual unknown No. Bdrms. 2-3 (proposed) XX- well If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation unkrlown Public Utility Individual (on-site) XX - S.T. Ut'Lknown EQ-037 (1/74)