HomeMy WebLinkAboutRICHTER PARK LT 1e
%1
Ol
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT,
Permit Number: OSP221255 PID Number: 015-471-01
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
BOWLBY ROBERT H LIVING TRUST
ABSORPTION FIELD
9 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
11101 HILLSIDE DR, Anchorage
❑ Other
Phone
(907) 257-04194
Number of Bedrooms
Soil Rating
Total depth from original grade
0.8 GPD/SF
11.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
8.0 Ft.
Subdivision Block Lot
Richter Park 1
Fill added above original grade
0.5 Ft.
Gravel length
47 Ft.
Township Range Section
Gravel width
3.0 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
752 Ft2
1
Ft.
Well
>100'
>1 00'
N/A
N/A
>25'
TANK Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
>100'
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>1 0'
>1 0'
N/A
N/A
LIFT STATION
acturer
Capacity
Remarks
Gal.
Alarm location
I installed by
Installer
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
JRs Septic
p
Drainfeld D3034 Co/MT D3034
Inspector L. Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspdecct sn 15t 7/25/22 7/26/22
Location and description
2�a
Bottom of window sill
3`d 41h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF�\� l
k�
Conditional Approval: Date
•' " .5,���¢
���Q't.
s*:49TM
Ben)a•*�
�� �••• rrt+3chiller •:�
CE
Septic System ��
A( ,v-- /
pprov Date v
12592 \
+ ,A- •
�• •8/19/22 . •`c
*%'
t�` PROFESS0W
Note: this approval does not include well permit requirements.
kRCv UUIU4110f
CD
cn
Z
cn
C:- >
C/)
I
o
rr
CD Jr
m
m
---I
0
W
�
IS
w
U).
CD
cn
Z
cn
C:- >
C/)
I
o
rr
CD Jr
m
m
---I
0
0
�
NO
w
tooflo<mo
PI)
—
co
co
--1
-4
--j
w
wl
.
p
--j
!, 0
� -0
W-,.)
r--4
.
cn
-
r,
--.4
w
I
C.n
cn
m
-rte
C.n
.
90
W
Gn
p
p
.IV
m
co
-Q-
19A
m
m
M
>
<
>1
m �
z '5 >
q z 0
co
CD
MIQ
(71
C)
>
> G)
�
Z -F
0 r
Z A z r >
CC)
00, X
C)
0
m ! v
C) O�, ��
0,
z
G)
m
r- , M -
to W?Iw
r >
r:
x >
0 OM 0 > r -
U) (n �u -4 z zm00 rI; :� -M,
m
-v
�M, z 0 (,� ;l 0 0< >
0 r- M m > m 0)
--j M-(/)
z Mmm
zx
'll 0 >rn
m w OD -A Im
mo m Cf)
0 0
x z
'CO UG)
cox
M 0 03
co
CD
1z o0
Cn
N
—,N
- 'XI
. . ........
>
cm C") C:
✓ z --I M
>
5- Z
M
>o
co 0
-u U) >
z -u 0
>
G) Mr
Z U) IT)
0
z
m
-a
0
C/)
cn
crl
cl
r-
RICHTER PARK, LOT 1
PERMIT # OSP221255 PID # 015-471-01
O
U 93.2 FINISH GRADE -
I— O
92.7 ORIGINAL GRADE :�E U
nn
89.7-189.7
'DRAINFIELD ROCK
81.7
48'
NO GROUNDWATER 7/8/22
—73.7
F-
eNeiNeea�Ne
PROFILE AS -BUILT
(NO SCALE)
.49 7H '
. �.
• '
.......
• •
Benja' Schiller • •'
®P� •• CE 12592 `moi
.•2.:12• •`�c�c'�o�
�,11`_ PROFESSIONP .e
Scale 1" = 40'
TRACT 8
Legend
yElectric Meter/Outside Power
LT, Tel. Pedestal
y Gas Meter co, Telephone Pole
l=m Culvert
(S; Septic —x— Fence
1`��SSeptic M.H.
® Deck 1, f Mailbox
IWi Water Well ;0 Concrete
—oma— Overhead Utility
1
kp0
-� HIDEAWAY LAKE DR.
_ :0 E. 113TH AVE. (PLATTED)
Oo
� o
N89* 56'45"E 274.98
2
o ;s�
i�
Lu V :1611LuI ��--��` as° Cs�
r�
o / 00
-�7— 377.3 GREENHOUSE 'r—s" ,PX
IT, G
'N
o,
22.0 I HED q \
1
P� I
cmI
\
X J / 297.76
S82' 06'29 -VI '
II �
I I �
i LOT 2
30.0' I
i I _--
�I
�I
General Notes
1. Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft.
2. This document is created by Frontier Surveys for the purpose of an
as -built survey for Robert H Bowlby Living Trust, only.
3. This document is based on Plat No. 76-81, Anchorage Recording
District.
Disclaimer
Lot 1
Richter Park Subdivision
42,472 Sq. Ft. +/-
11101 Hillside Drive
4 Story Wood Frame House
With Attached 2 Car Garage
183.2
1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible
improvements and conditions at the time of the survey. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the
responsibility of the Owner to determine the existence of any easements, covenants, or restriction
which do no appear on the record plat. Under no circumstances should this document be used for
construction or for establishing a boundary or fence line.
0 20 40 80
Scale in Feet
LOT
LOT
�'N
'C.�P
..�' I1.... A .
Pierre M. •Str ler
n •• No. L.S. - 9 12
fF9 ' • 08/2412022 • • • ,,r
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221255
Work Type: Septic Upgrade
Tax Code Number: 01547101000
Site Legal Address: RICHTER PARK LT 1 G:2640
Site Mailing Address: 11101 HILLSIDE DR, Anchorage
Owner: BOWLBY ROBERT H LIVING TRUST
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
cnt
m00%
Dei)arCnlent
7/21/2022
7/21/2023
42472
Q Disposal Field Z Septic Tank Holding Tank Privy Private Well Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
Date:
Date:
4
MUHUFAA TY OF �, HCHOR GE
Community Development Department k` Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel 1. D. 015-471-01
Property owner(s) Robert BOWIby Living Trust Day phone (907) 257-0419
Mailing address 128 Buckingham Ave, Syracuse, NY 13210
Site address 11101 Hilside Drive
Legal description (Sub'd., Block & Lot) Richter Park Lot 1
Legal description (Township, Range & Section)
Lot Size 42,472 Sq. Ft. Number of Bedrooms
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF)
Septic Tank
❑X
Upgrade ❑X
(w/wo AD U)
Holding Tank
❑
Renewal ❑
Duplex (D) ❑
Privy
❑
Multiple Dwellings ❑
(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
applicable Municipal Codes.
I further certify that this is in accordance with
(Signature of property owner or authorized agent)
Permit/Rush Fees: J% Waiver Fees:
Date of Payment: ° G Date of Payment:
Receipt Number: C) J. lib Receipt Number:
Permit No. o5p�2 �? a 5 5 Waiver No.
Permit App_::- : ,_.,:c
July 8, 2022
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Richter Park L1 – 11101 Hillside Drive
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot has a failed septic on the property, so we are submitting this permit
application for the construction of a new septic system. The existing house has 2 bedrooms but the
client would like to upgrade to a 4-bedroom system. The attached site plan identifies the location
of the home as well as the existing well and septic location, and new septic site. No conflicts exist
between this proposed system and any other well or septic system, whether on this lot or adjacent
lots.
The ground surface on the lot slopes toward the east under 10%. There are no slopes greater than
25% within 50 feet downslope of the proposed site. Elevations are shown on the site plan showing
the grade and direction of flow. Stormwater drainage will not impact this septic system. The new
trench will be constructed parallel to the slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. The alternate site is located
more than 16’ away.
Please refer to the attached test hole log, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221255, Deb Wockenfuss, 07/21/22
// // // NOTE:
NO SLOPES >25% ARE WITHIN 50' OF THE PROPOSED SEPTIC SYSTEM. NO SURFACE WATER WITHIN 100' OF
THE SEPTIC SYSTEM.
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH
WELLS OR SEPTIC SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
1"=50'
2-BDRM HOME
RICHTER PARK, LOT 1
FEET
0 50 100Benjamin Schiller
CE 12592R
EGISTEREDPROFESSIONA LENGINEER7/8/2022
HIDEAWAY LAKE DRIVE (E 113th AVE.)
20' ROAD
PRESERVATION
EASEMENT
10' UTILITY
EASEMENT
850
855
860865 870
875
870
865
1,250 GALLON
SEPTIC TANK
w/ 20" MANWAY
DECOMMISSION
EXISTING CRIB
& SEPTIC TANK 2CO
2CO
CO
MT
CO
EXISTING WELLS
w/ 100' RADII
MOA MAPPED POND
& STREAMS
100' SEPTIC
SEPARATION FROM
SURFACE WATER
47' LONG x 3' WIDE x 8'
EFFECTIVE DEPTH
ABSORPTION TRENCH
≥10'ALTERNATE SITE:
CAT III SYSTEM 10' LONG x 3' WIDE
x 8' EFF DEPTH ABSORPTION
TRENCH, APP RATE 5.0
WETLANDS PER
MUNI MAPPING
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221255, Deb Wockenfuss, 07/21/22
RICHTER PARK, LOT 1
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
6"
2'-6"
8'
DESIGN FACTORS:SYSTEM REQUIREMENTS:
*600 GPD PEAK FLOW
PERK RATE: 6.7 MIN/IN
APPLICATION RATE: 0.8 GPD/SF
8' DEEP TRENCH SYSTEM
1250-GAL SEPTIC TANK
BOTTOM OF TRENCH: 11' BELOW GRADE
FLOW LINE ELEVATION: 3' BELOW GRADE
TOP OF TRENCH: 6" ABOVE GRADE
600 GPD / 0.8 GPD/SF / 8' DEEP / 2 SIDES = 46.9 LF TRENCH REQUIRED (47 LF SPECIFIED)
7/8/2022
GEOTEXTILE FABRIC
*EXISTING HOUSE HAS 2 BEDROOMS.
THIS SEPTIC DESIGN IS FOR 4
BEDROOMS IN CASE OF FUTURE
UPGRADES.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221255, Deb Wockenfuss, 07/21/22
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
6.7
6/24 1
2
3
GM (SILTY SANDY GRAVEL)
Professional Engineers Stamp:
NO
Richter Park L1
6/24/2022 015-471-01
Connie Giddings
1:341
2
3
5 0
16
2:05
2:36
1' OB
30
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER7/8/2022
PERC TEST LOCATION
TECHNICIAN: J. Millette
9 8
16
N/A
DRY
7/8/22
COMMENTS:
6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING
SITE PLAN
4 8
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
B.O.H.
5 0
1630 9 8
16 4 8
16
5 0
1630 9 8
16 4 8
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221255, Deb Wockenfuss, 07/21/22
U.S. ARMY CORPS OF ENGINEERS
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB APPROVAL NO.0710-0003
33 CFR 325. The proponent agency Is CECW-CO-R. EXPIRES: 28 FEBRUARY 2013
Public reporting for this collection of Information Is estimated to average 11 hours per response, Including the time for reviewing Instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of the collection of Information, Including suggestions for reducing this burden, to Department of Defense,
Washington Headquarters, Executive Services and Communications Directorate, Information Management Division and to the Office of Management and
Budget, Paperwork Reduction Project (0710-0003). Respondents should be aware that notwithstanding any other provision of law, no person shall be
subject to any penalty for failing to comply with a collection of Information If It does riot display a currently valid OMB control number. Plesse DO NOT
RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having jurisdiction over the location of
the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries
Act, Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on
this form will be used In evaluating the application for a permit. Routine Uses: This Information may be shared with the Department of Justice and other
federal, state, and local government agendas, and the public and may be made available as part of a pubilc notice as required by Federal law. Submission
of requested Information Is voluntary, however. If information Is not provided the permit application cannot be evaluated nor can a permit be Issued. One set
of original drawings or good reproducible copies which show the location and character of the proposed activlty must be attached to this application (see
sample drawings and/or Instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application
that Is not completed In full will be returned.
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO. 2. FIELD OFFICE CODE 3. DATE RECEIVED 4. DATE APPLICATION COMPLETE
(!TENS B&OW TO BE FILLED BYAPPLICAAM
5. APPLICANTS NAME S. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
First - April Middle - Last - Beier First - Benjamin Middle - Last - Schiller
Company - Company - Forge Engineering, Inc
E-mail Address - aOl.beier(@gmail.com E-mail Address-ben@forgecivil.com
B. APPLICANTS ADDRESS: 9. AGENTS ADDRESS:
Address- 128 Buckingham Ave. Address- PO Box 240773
City - Syracuse State - NY zip. 13210 Country - USA City - Anchorage State - AK Zip - 99524 Country -USA
7. APPLICANTS PHONE NOs. WAREA CODE 10. AGENTS PHONE NOs. WAREA CODE
a. Residence b. Business c. Fax a. Residence b. Business c. Fax
315-313-6754 907-310-9090
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Beniamin Schiller, PE to act In my behalf as my agent In the processing of this application and to furnish, upon request,
supplemental Information In support of thi It app'�?
7121122
3133NATURE OF APPLICANT. DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see Instructions)
11101 Hillside Dive septic replacement
13. NAME OF WATERBODY, IF KNOWN (If applicable) 14. PROJECT STREET ADDRESS (if applicable)
Unnamed wetlands Address 11101 Hillside Drive
15. LOCATION OF PROJECT
Latitude: -N Longitude: -W Cit' - Anchorage State- AK Zip- 99507
10. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID 015-471-01 Municlpallb/ Anchorage
Section - Township - Range -
ENG FORM 4343, OCT 2012 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 3
17. DIRECTIONS TO THE SITE
Seward Highway to O'Malley Road to Hillside Drive to Upper O'Malley Road to Hideaway Lake Dr
18. Nature of Activity (Description of project, Include all features)
The project will involve excavating a trench for a septic system as well as a hole for a septic tank.
19. Project Purpose (Describe the reason or purpose of the project, see Instructions)
The existing septic system for the home has failed, and this project will provide a vaUd septic system that meets all separation distances
from the existing system and from the well on the lot.
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
The existing material, approximately 45 Cy, will be removed and replaced with clean septic rock to allow for secondary treatment of
septic effluent and infiltration into the ground. This is needed because the existing system has failed and cannot be used for the home
anymore.
21. Type(s) of Material Being Discharged and the Amount of Each Type In Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
Clean sewer rock, 42 CY
22. Surface Area In Acres of Wetlands or Other Waters Filled (see Instructions)
Acres 0.02 Acres of wetlands (800 SF)
or
Linear Feet
23. Description of Avoidance, Mlnlml¢atlon, and Compensation (see Instructions)
The wetlands cover most of the undeveloped portion of the lot, although they are not officially delineated and only come from the MOA
wetlands mapper. Current test holes indicate no groundwater down to 19'. There is no possibility of avoidance due to the requirement of
gravity flow from the exisitng home. The amount of disturbance (under 0.10 acre) does not require mitigation or compensation.
ENG FORM 4M, OCT2012 Page 2 of 3
24. Is Any Portion of the Work Already Complete? Yes gNo IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody trr mors then can be entered hent, plum a tch a aWpramancel lat}
a. Address- William & Jackie Dunbar, 9622 Victor Rd
City - Anchorage State - AK Zip - 99515
b. Address- Phyllis Rhodes & Pamela Richter, PO Box 1000714
City - Anchorage State - AK Zip - 99515
e. Address -
City - State - Zip -
d. Address -
city - State - Zip -
e. Address-
city.
ddress-
city- State - ZIP -
26. List of Other Certificates or Approval&Osntals reoeived from other Federal, State, or Local Agencies for Work Described In This Application.
AGENCY TYPE APPROVAL" IDENTIFICATION
NUMBER PATE APPLIED DATE APPROVED DATE DENIED
` Would Include but Is not restricted b zoning, building, and flood plain permits
27. Application Is hereby made for permit or permits to authorize the work described In this application. I oertify that this Information in this application Is
complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duty authorized agent of the
applis
7/21/2022 BenJamin Schiller na�0a��x
2022-07-20cSIGNATU
DATE SIGNATURE OF AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or It may be signed by a duly
authorized agent If the statement In block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, In any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, & herne. or disguises a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing some to contain any false, fictitlous or
fraudulent statements or entry, shall be fined not more than $10,000 or Imprisoned not more than five years or both.
Cm's PURM 4344 OUT $012
Page 3 of 3
LOT 2LOT 3TRACT BLOT 7;;;;;;OHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUS00° 02' 00"E 124.00S82° 06' 29"W 297.76L=31.41R=20.00N89° 56' 45"E 274.98PAVED DR
IVEWAY
10' UTIL. ESMT.
20' ROAD RESERVATIONHILLSIDE DRIVEWSSETMB
℄ HIDEAWAY LAKE DR.E. 113TH AVE. (PLATTED)30.0R.O.W.30.0'SHEDGREENHOUSE35.371.022.037.357.561.4183.236.332.036.332.012.812.212.41
5
.
9
G100' WELL RADIUSN00° 02' 00"W 144.59
Lot 1Richter Park Subdivision42,472 Sq. Ft. +/-11101 Hillside Drive4 Story Wood Frame HouseWith Attached 2 Car GaragePREPARED BY:FRONTIER SURVEYS, LLC650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518907-460-1686DRAWN BY: CHECKED BY: DATE: SCALE:DRAWING ID: SHEET 1 of 11.Excepting for gross negligence, the liability for this survey shall notexceed the cost of preparing this survey. Dimensions to property linesare plus/minus 0.1ft.2.This document is created by Frontier Surveys for the purpose of anas-built survey for Robert Bowlby Living Trust, only.3.This document is based on Plat No. 76-81, Anchorage RecordingDistrict.General Notes DisclaimerLegend1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visibleimprovements and conditions at the time of the survey. This document does not constitute a boundarysurvey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is theresponsibility of the Owner to determine the existence of any easements, covenants, or restrictionwhich do no appear on the record plat. Under no circumstances should this document be used forconstruction or for establishing a boundary or fence line.PS1" = 40ft06/01/202222-264KCScale 1" = 40'AN AS-BUILT SURVEY OFLOT 1RICHTER PARK SUBDIVISION11101 HILLSIDE DRIVECONTAINING: 42,472 Sq. Ft. +/- (RECORD)RECORD PLAT: 76-81Gas Meter Electric Meter/Outside Power DeckSepticTelephone PoleFenceMailboxOverhead UtilityWater WellTel. PedestalConcreteMB GES[TWCulvertPierre M. StragierNo. L.S. - 981206/01/2022REGISTEREDPROFESSIONALL
A
N
D
S
U
RVEYOR
VJ V� U Cl V � C l R/` L � TY 0 LI /\ tJ 'U C H 0 RAG E
A'd
Development Services
p ces Department Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-471-01
1. GENERAL INFORMATION
Complete legal description Richter Park, Lot 1
Location (site address) 11101 Hillside Drive
Expiration Date: 12- 2_Z
Current property owner(s) Robert H BOWIby Living Trust Day phone
Mailing address 128 Buckingham Ave, Syracuse, NY 13210
Real estate agent Connie Giddings Day phone (907) 244-6463
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
4. TYPE OF WATER SUPPLY:
Date of Payment
TYPE OF WASTEWATER DISPOSAL:
Private Well
FK
Private Septic
❑e
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Waiver Fee $
Date of Payment
Date of Payment
Receipt Number
Receipt Number
COSA #
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 8/23/22
2 WAST v'AT
�,o. GRAM .�`'0
BY Original Certificate Date: q-6 -2-zz
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
i
Well Flow Advisory Other
COSA Checklist blue sheet
OF k
�lowAV
y,�Q'.
TH
6. DSD SIGNATURE
System #1 Approved
:. .. • .. • • • • : :
/
for
bedrooms
• rr�,• chiller /
Benja
System #2 Approved for
bedrooms CE �<`� •.. CE 12592 .• i��r
?�
Disapproved
l`F�. pROFESSION�
Conditional approval for
bedrooms, with the following stipulations:
2 WAST v'AT
�,o. GRAM .�`'0
BY Original Certificate Date: q-6 -2-zz
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
i
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Richter Park Lot 1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1963*
Total depth 134* ft
Cased to UNK* ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 5/17/22
Static water level at beginning of test 91 ft.
Comments *Data taken from MOA files
B. TANK DATA
Age of tank(s) `1
Tank type/material
_ years
Septic/Plastic
Measured operating fluid level in septic tank N/A
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New installation 7/25/22
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/26/22
NO ALL standpipes present per record drawing
Total measured depth from grade 11.0 ft (max)
Measured depth to pipe invert from grade 3.0 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 015-471-01
Structure served by this system
Well production at time of test 4.5 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ON No
❑ Coliform bacteria is Negative
Nitrate 5.16 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 8/15/22
C. LIFT STATION
uired maintenance completed
Age of lift statio years
Lift station material
Comments:
Adequacy test date NEW
Results ❑ Pass For 4* bedrooms
id depth prior to test in
Water ded gal
New depth
Elapsed time min
❑ Code -required soil cover over field
Final fluid depth
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 1
date of test) If yes, enter date
Gallons introduced _gallons
Comments/Deficiencies: *This is a two bedroom home with a four bedroom system
COSA Checklist yellow sheet
S)
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
✓[l
Yes
Community Sewer Manhole/Cleanout > 100'
M✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' [D Yes
if No
ft
Private Sewer/Septic Line > 25' F71 Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' 0 Yes
if No ft
M Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' �✓ Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Yes if No ft
Property Line > 5✓Q
✓[l
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Main > 10'✓Q
✓l
Yes
if No
ft
Community Wells > 200'✓Q Yes if No ft
Water Service Line > 10'
El
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
✓[l
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓l
Yes
if No
ft
Private Wells > 100' Q✓ Yes if No
Water Service Line > 10'
El
Yes
if No
ft
Community Wells > 200' Yes if No
Surface Water > 100'
✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION ,® AJ
On�
I certify that 1 have determined through field inspections and review'••49 11'!
of Municipal records that the above systems are in conformance with ;'01 ...•" , . ...
MOA COSA guidelines in effect on this date. .
Benjarr>�yr chiller •:�
t¢ �� •. • CE 12592
8/23/22
8/23/22 *& , • •
FROFESSIONP
COSA Checklist yellow sheet
ft
iii
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221439
Subdivision: Richter Park Lot 1
A water sample revealed a nitrate concentration of 5.16 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Ma�lmg address P O Bax 196650 * Anchorage,'Alaska 99519 6650 *www muni org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519;6650-eN
*www muni org
~ 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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency /~,/.~,/L/, ~,'~. /~¢/~O'~ZCCe L~.'¢r'P. Day phone
Agent /~d/~///¢g ~ gE' Day phone /~//~
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If 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
Holding tank
Community on-site
Public sewer
NOTE:
X
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev 1/91) Front MOA ~21
o
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/orwastewaterdisposal system is safe, functionaland 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 flies 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 _ ,~,,~/'/'/ ~cT)?SLL/~r?/9 ~ Phone
Address /¢.¢. ,-"~¢)~ //£)Z~/ _,,~/i')o/-,,.)~,~
Engineer's signature ~/H, _~.~,/)./~'.A-~ Date ~-2~-~'-,~Z
DHHS SIGNATURE
X. Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional comments
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
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L(} r i / /c'Hrm Parce
A. WELL DATA
Welt type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
ADEC water system number
. . /?~ ..
Date completed ~ Dr Iter /.~l~l~lOLdl~I
Cased to /_.jA//~/dOgJ'/J Casing height /~)/~'~/¢/.)X.
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
~ ../(..~ .¢i~MUNiOPALI fY OF ANCHORAGE
~'~-,~v'iF, oNMENtAL SERViCeS DIVISION
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
r~' (:OI'~PLIT/~I) £[) C.D. ; On adjacent lots
~)~¢ C.O,,~/'L~TEf) 'FO AC. ~ ; On adjacent lots
Public sewer manhole/cleanout /V/:)
Petroleum tank ,A/D ,UE
WATER SAMPLE RESULTS:
Coliform ~() tL ~
J
Date of sample:
Nitrate /, ~n.~o/'~. Other bacteria
Collected by: J~,
B. SEPTIC/HOLDING TANK DATA
Date installed /¢'/~ Tank size /(*~)0 Compartments
Cleanouts (Y/N) ~J /,,'*~".L Foundation cleanout (Y/N) ~J Depression (Y/N)
/
High water alarm (Y/N) /~/~ Alarm tested (Y/N)
Date of pumping ~ :'/¢ -~Z Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~A 7{~'~o
To property line ~O/~ ~' Absorption field
Surface water/drainage
72-026 (Rev. 7/9U Fronl :)~ /~)~7"/) T/ORE/J t~RO/t/ i't40/¢ tW~/Z.'5_ CONTINUED ON BACK PAGE
~'d--~_~__.... M an ufactu rer
Size in gallons -~--....._.._~__~.... Manhole/Access (Y/N)
Vent (Y/N) "Pump on';*'~
leveFat...~_ "Pump off" level at.
High water alarm level ...... '~---C~les tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water .....
D. ABSORPTION FIELD DATA
Date installed ;'~,~'~/~ Soil rating /~/¢~ £¢~0£¢/(¢. (/
/
Length ~O/F~d~F~e;YWidth/~'~CG~(/~ct Gravel thickness ~ Fr~e:~fc/~/Total depth
Total absorption area ~ Cdd~6/ Cleanouts present (Y/N) ~
Depression over field (Y/N) /~'
Results (pass/fail) /O4' JS'
Peroxide treatment (past 12 months) (Y/N)
System type
Date of adequacy test ~ '-/~ '19Z
for ~.
/¥/ If yes, give date A//,)
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~/z~/O~/;"r3 ,~//~f~zd MKOn adjacent Iots~Property ~ine .~'~:~'/~<
To building foundation ~'~'/ To existing or abandoned system on lot
On adjacent lots /.O¢'tJ/'/,';/~u',,,~/~p(~/Cutbank 4~.~/'0~' 4~- Watermain/serviceline
Surface water ,~'z','/~ /,gD' Driveway, parking/vehicle storage area ~/~,¢~/'/,'~.
Curtain drain ./V/~(.¢
E, ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the dat_~,of this inspection.
Signature
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (Re','. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
RECEIVED
SEP 9199t).
Municipahty of Anchorage
Dept. Health & Human Services
SKU'I N,.,- :
SKLH CONGULTANT~
~.0. Box 110261
Arlchorage, AK 99511
(907) 345-6947
FAGB 1M I LE T RANS M I S S I ON
CTotal Number ,:,f page~ 3)
Att: ** MR. JOHN SMITH~ ~'. E. **
Dept. of Health and Humor, B~'vices
Mur,~cipality of Ar~h,-_~rage
Ar~'h,.-,,r. ag~, Alaska DgDO1
Fa¢.~sir~le No. 34b-6'740
Neff: L.G,t 1 Riohter' P'a~-k Subd~v~i,'.~,~
Mr. Smith,
Attached is th~ field data take~ during the adequacy 'be~t ,:,r, the
subject ~r,:,p~.~ty. Thi~ ~y~t~m is marqir,~l ar,~ I suspect will fail
~oor~; however, it did ab~opb the minimurm] requir'ed ab~(;.~ptior, arnount
~of ~ ~?~b~drc,,:~rn hO,,~s~ of 300 ~allor, s ir~ ~4-hours. This wa~ dete¥'m:ir, ed
g~'aphically as showr~ ¢,~ the atbach~ ~o~-~og gPaph.
I00 'd ~.(z09-!~l~E; In~UOO H]:~$
~'.0. B,:,X 110261
Ar(~h,:,~ag~ AK 99511
~9~) 345-694?
T[ T
_EN~PECT 0 P.;
TYpt~ OF S~M 5i~1~.
DATE.
,Stm'~¢ TA~ k
Tl'f~ oF .,SA.5:
~_xl~ ~
RECEIVED
SEP 9 1992
Dept. Health & t-luman Services
g00 'd Ll~Og-fil~S I nsuoo H']Y,S ~O~d
ses,!^.~eS ueu.ml4 '9 ~.llleeH 'ldeo
866[ 6 d~S
STEVEN A. JOHNSON and Associates
P.O. Box 76 · Chugiak, Alaska 99567 0 (907) 688-3085
October 19, 1978
Department of ffealth and
En¥~a?onmental ProtectS. on
Pouch 6-650
Anchorage, AK 99502
Attent~_on, Mr. Bob Pratt
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 9 1978
RECEIVED
Adequacy test for t~r. Dom Richter on Lot 1, Richter Sub~
division
Dear ['4z'. Pratt,
Enclosed please find a copy of 'the results of an adequacy 'test
performed by me on the above mentioned property, While on the
property I inspected the septic 'tank and found ~.t to be off
suitable design and co~3struction. Please address your letter
of approval 'to~
~r. Don Richter
c./o Alaska Teamsters CredJ~t Union
1200 Airport Heights
Anchorage, AK 99509
Attn~ Jean Oldre
Please contact me at 688~3085 or Mr. Jorgen L~.lliebjerg at
274~2317 when your letter of aporoval has been drafted as we
will hand carry it to Alaska Teamsters Credit Union,
mhank you for your cooperate, on.
//~,/~Sincerely, ~
SEeven A. JohnsOn
Eng~.neering Geologist
Enclosure
Consulting services for:
On-site water and sewer systems, geotechnical and mineral exploration programs, site suitability studies
i OATA SHEET SEEPAGE PIT
~":''"~' ;' ' . Date Started
~:~:~[:al Description ' - ~ l ~',ak~,~ <',~ Pumper
''umber. of Bedrooms~
~.) ,.e~,t Volume (TV) =
'~able
,. $ ~ AST
8o0
/-[ Tank ?umped X Yes__
Bedrooms x l~O gal/Bedroom =, ~ ~ ~1
2 x ~V = 2 x__~_gaY
'ime at beginning of pumping (T:p)
lO, o
' ' ' 1000 '
.._ 1~00 ................
1~00
~00
- t 80O -
2) System capacity (SC) = 200 ~!.tllon.s = gal/in
SP
~) Surge volume (SV) :; 0.!¢ TV = 0.4 ~. cO Kal =
¸i'
,,?
Fluid level drop ( FL) =
X + X
~O~-~ 1 ~,YO'-,-¥[Y 2 9'0'-~ff 1
Table 2
? (rain) AT (min)
j; 0 .......................
(.pCb
__ID-LO _
= lO 'gai/mLn '
= C9 b- .g~l/day
. Surge C:.tpacity ('XC) = SV
IhT
Day I I
Fluid Lost (FL) = SC x (SP24 - SP )
Perc.ola%ion R~te (PR)
SUmm&ry
' ' ' /
Surge Capacity, (XC) = .O gal mtn
Percolation Rate (PR) =
~ ~v-~-~¥-~hn s o n/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825LStreet-Anchorao.,Alask. 99501 SEP 2 5 1978
ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page ', Incomplete requests will not be processed, Please allow ten (101 davs for orocessing,
PROPERTY RESIDENT (If different frorrr~bove~ -- -- ~ PflONE
·
MAI I_1 '4G ADDRESS
3, LENDING INSTITUTION '"_~ + z ~ A~ ,;r- .,~ I PHONE
MAILING A~bR ES~
[4, ~ALTOR/A~EBT
5 LEGAL DESCRIPTION
~TR~~-
~ ~ One : Four : Other
S NGLE FAMILY 7we ~ Five
~ MULTIPLE FAMILY ~ 7~re0 ~ Six
7. WATER SUPPLY
~' INDIVIDUAL" I.~4/ "ATTACH WE LL LOG. A well log is required for all ,w. olls drilled
COMMUNITY since June 1975. For wells drilled prior to that dat ,~give well
[~ PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
**If individual/on-site, give installation date
NDIVlDUAL/ON-SITE**
f 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)
I , ,,/i ,;~ ,; (,.,.. ........... , '(,, ~- ,,.:,.,.,.' .,. ,,-,, . _. .-
)
THIS SIDE FOR OFFICIAL USE ONLY
DATE"RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] sINGLE FAMILY [~] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
E~]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES-wELL TO:- Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTs ......
PPROVED BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE I BY (Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78}