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HomeMy WebLinkAboutANGELA HEIGHTS LT 10Angela Heights Lot 10 #050-283-46 tIrrtifirb faig ,��� by A & L DRILLING COMPANY w BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 �j OWNER OF LAND OLE 6/(, %0-0ZE /W DEPTH OF WELL /4 I ADDRESS STATIC LEVEL OF WATER FT /1/ LEGAL DESCRIPTIONT /0 %C t:t:r"/- ' - `��PP ? DRAW DOWN FT / Q DATE - Started 't/ /74', Ended 'i/777G. GALS. PER HR,� ffJ C/ `� Fr' i L PERMIT NUMBER 76 3 7 KIND OF CASING KIND OF FORMATION: From 0Ft to Ft 5.../9‘15.../9‘1-42(��CCY'-'xL From_ Ft to Ft From y _ Ft. to `a Ft. %7J�P From Ft. to_ Ft. From 3-S Ft. to ca Ft. (f'?r ;,* 6 OhJEL. From Ft. to Ft. r• From -Ca Ft. to 5-1.1 Ft. .-56" 0f tgL;i: i. From Ft. to Ft. From. L_Ft. to Ft (1cr` $ 4eN"/'` `' , /30‘)4401±-7i4om Ft. to Ft From -7a Ft. to I'S. Ft. 9?/4;)(2 From Ft. to Ft. From Ft. to '6 Ft. a2.)ki- 644",e144:77 4- From Ft. to Ft. From (16 Ft. to / 3/ Ft. CL/Ciei 64'd4.aZ-ee, From Ft. to Ft. From / 3/ Ft. to 14a Ft. 5'°'-'d a hi ai ' `- WFi1e�rFrom Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft to Ft. From Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft to Ft From Ft. to Ft MISCL. INFORMATION: N. 6 ti': Tri (e- 9 54= f C 3i; �:a?°TI i Gy ¢� k'i c.'�lb.�lbi.J_� l?�.,.a:i'1 [-•t� (Y) d DRILLER'S NAME r"" ' x?. MUP4 DEP IEW HEALTH AND ENVIRONMENTAL ZOTECTION 10 E. TUDOR RD.: ANCHORAGE: AK. 99507 276-2221 WEEL.A._ Ell(‘ 7630 OLD HARBOR AVE PERt1 1 TiO. 237 ) APPLICANT G ED R COFCTRUC LOCATION CH CKALOON ST LEGAL L10 ANGELA HGTS 333-7505 LOT SIZE 12276 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. VIRLIC) IF -04R 01%1e VEFR IF-FZOM is-nr=3ue CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL I7S- ALL THE SYST IN ACCORDANCE WITH THE CODES. SIGNED: APPLICANT Ik4 ISSUED B'e t 0 REINER CONSTRUC ,2tee DATE (5. 7C / Municipality of Anchorage April 6, 1979 POUCH 6-650 �J-)� �� 9 ANCHORAGE, ALASKA 99502 (907) 279 2511 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Street) Charles L. Jennings 122 Chickaloon Eagle River, Alaska 99577 Subject: Lot 10 Angela Heights Subdivision Approval for your individual sewer and water facilties will not be granted until the following items have been completed: (1) Expose the well for our inspection to determine proper construction, also, to insure the minimum distance requirements are met between your well and sewer system. (2) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. Notify this department for a re -inspection when descrepancies have been corrected. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Mortgage Loan Department Post Office Box 720 99510 Parcel I.D. 050-283-46 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 EPuNS� U Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Angela Heights Lot 10 Expiration Date: [::-k 0, 96/7 Location (site address) 10233 Chickaloon Street, Eagle River AK 99577 Current Property owner(s) Wyatt & Suzanne Wheeler Day phone Mailing address 10233 Chickaloon Street, Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer Fx I WaiverNariance request for: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -Nwb Waiver Fee $ Date of Payment t l i; Date of Payment 0 Receipt Number �) ���, Receipt Number COSA # nbi 13 I ✓ ,Q Waiver # 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 1AILCI sy�- Conditional approval for bedrooms, with the following stipulations: By: � Original Certificate Date: o\i adole 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 Well Flow Advisory Other COSA blue sheet r .. Legal Description: Angela Heights Lot 10 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Date completed 9/7/76 Sanitary seal (Y/N) Y Total depth 142 ft. Cased to 142 ft. FROM WELL LOG Date of test 9/7/76 Static water level 111 ft. Well production 25 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 2,82 mg/L Arsenic ND ug/L Date of sample: 10/25/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material N/A Tank size gal. Number of Compartments _ Foundation cleanout (Y/N) Depression over tank (Y/N) Date of pumping Pumper If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Parcel ID: 050-283-46 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 25 in. AT INSPECTION 10/25/18 96.7 ft. 6+ Collected by: PES Date installed Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed N/A Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed N/A "Pump on" level at_ Datum _ Size in gallons _ in. "Pump off' level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot n/a Absorption field on lot n/a Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation n/a Property line Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line n/a Building foundation _ Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 10011+ Public sewer manhole/cleanout 100'+ Holding tank n/a Manure/animal excrete storage areas 100'+ G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 11/1/18 COSA canary sheet_2-6-15.doc Absorption field Surface water Water main Driveway, parking/vehicle storage .91 W., , rinone S}e CE -8149 r A. AW in. Hm z c� > H a a n x 'O H:9 HCHm 3 H x D Z D o H v N a r b c m n D b m 3 E Z C H H t'1H GInHZ H Z Z HmGI �l3 HC H rn 9 Z H < n A m H E N Z b E N D Z K CHICKALOON STREET N 00 01' E 93.00 N 00 01' E 93.00 v m -i > r 0 1-+ > Ao �<i > N x z p W -1 m VI n O m m v -i -o a,O o x� C �r� mm H Q >oom> > co r -1 -1 'O clE-D N m m H m m o i v > m� 3 r> r n -m C �zm-i•v� n < X m r x O A A x-1 O n frl E 1 rn oxr<o t-- X>t-. m: z n < > z Z 3 v c l< tvomm1-+ Omz wzz C v -i —. o -i c, m mx 00> -1> N 1- m z v N> ,--. n-4 V) 3;. +1 w. .w ... > JC z-1 -1 > a, r > ocz mx m a�- va -i H i n C1t < t' x m -i -o m to r CvJ O � C -4 > -v m II r :-r- r m ;-am m> X -n (U oN N mmT. -1 o <z C ? z o > 3 an z, m v nicr� Im H FoG:r o» > A z > > lz nmv v x N y m 4 > 3: c wbac -< mi -+x ;v x O z�> < m O < S< m N H m < oOc) Z -1 G V x m N 00 01' E 93.00 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING cOSA# CSC <<►9aa Parcel I.D. 050-283-46 1. GENERAL INFORMATION- Completelegaldescription Angela Heights S/D, Lot 10 Expiration Date: 14 — 3 - / a. Location (site address) 10233 Chidcaloon Street, Eagle River, Alaska Current Property owner(s) Anthony Funch Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10233 Chidcaloon Street, Eagle River, Alaska 99577 Day phone Residential Mortgage Day phone Kathi Olmstead, ReMax of Eagle River 111525 Old Glenn Hwy, Eagle River, AK 99577. Day phone 907-244-5020 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank Community On-site Public Sewer ❑ ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 4 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 ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Douglas T. Kenley, P.E. Phone (907) 746-4073 Address 9806 E. Northstar Circle, Palmer, AK 99645 Engineer's Printed Name Douglas T. Kenley Date 1Z • 21.1( 5. DSD SIGNATURE 1-,""'.Approved IGApproved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulatidnS • Y OF' c 4 :•...•. ya `*'• ON-SITE •'• WATER AND , m- WASTEWATER : nnnnriAAh • 4 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory 1)»»»711 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ,7 � (Rev. 11/05) Original Certificate Date: 1-- 3 " I SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1115609001 Douglas Kenley P.E. Angela Heights SD Lot 10 Outside hose bib Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 11/23/2011 16:38 11/15/2011 13:30 11/15/2011 16:35 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department ND Total Nitrate/Nitrite-N ND Microbiology Laboratory Colony Count Fecal Coliform Total Coliform 0 0 0 5.00 ug/L EP200.8 C (<10) 11/16/11 11/23/11 NRB 0.100 mg/L SM204500NO3-F 13 (<10) co1/100rnL SM20 922213 col/100mL SM20 922213 col/100mL SM20 922213 A A A (<200) (<1) (<1) 11/22/11 AYC 11/15/11 DLC 11/15/11 DLC 11/15/11 DLC Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program • 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 'C) ---O-?] - LP 1. GENERAL INFORMATION Complete legal description Lor/L,.4,,Va, .4 Location (site address or directions) Current Property owner(s)-I) C..V\ V\ 1S phone 6 9 y4-335'9 .4.€G - -99%S.77 HAA # �-1 �� Expiration Date: q - /ex,'" ,4646' �;04s- Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ❑ 0 0 lEr Individual On-site Individual Holding tank Community On-site • Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. / Name of Firm 17.04re4- 'S .vc' G G�'� Phone `�o r✓ �y���v73 Address 9960 E; M5.6eAse•u..C7.e, Engineer's Printed Name .o.6'cp<e-'4:c Date 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulation��q�•' By: 69- ts- • og • • DOL S T. KENLEY: 41`�'•'• CE8176 ,•' Additional Comments (tofforicir, ANer . 6 6 6. ON-SITE '; 0 : WATER AND WASTEWATER : PROGRAM ; • •••• ,\\ S \1\ ...,„atmJl. tSEN v` Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory ' Supplemental Engineer's Report Well Flow Advisory , Other (Rev. 01/02) Gr/ Original Certificate Date: G - ,2 J - 0 Legal Description::`h A'. WELLDATAi j 11, ir ; Well type ,C� ?.c$wrc Datecompleted9l/ Total depth i`r. ft. • Municipality of Anchorage rG�� fY.n Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 S_outh'Bragaw St. P.O. Box 196650 Arichorage,'AK 99519-6650_.y www.ci.anchorage.ak.us (907) 343-7904 ifi Yf+! .11.111. SAF err HEALTH AUTHORITY APPROVAL CHECKLIST: or"! d'14)44'-'4-'4( Parcel ID 0s-o"a g 3 1 C. Date of test ! , Static later level Well production -fs -/E/�� Ts If A, B, or C provide PWSID # y� Sanitary seal,(Y/N). y Cased to 11'4 ft. FROM WELL LOG 'ii/ WATER SAMPLE RESULTS: ;f g.p.m. Coliform I' - colonies/100' mi • Arsenic: l; mg /I. I . Tank size Foundation clean Date of pumping ABSORPTION FIELD DATA Date installed Length Total depth _ Ift: ly Date of,adequacy test Fluid depth in absor B. SEPTIC Nitrate ,3• �6 mg./I. Well Log (YIN) y Wires properly protected (Y/N) I i ; Casing height (above ground) I. AT INSPECTION q i a ! ft. 4 •� Ig.p.m. Other bacteria •?"-- colonies/100 ml. Date ofsample: %y j I . Collected by: 'Ai /HOLDING TANK Tank Type/Material, l ; DATA e gal. `Number of Compartments " out (Y/N)' Depression over tank (Y/N) i_ # i Pumper , Elapsed • li '' 'Soil rating' (g p.d./ft2 or'ft2/bdr ,Width �` ft Eff. absorptio n field before test a Date installed Cleanouts' (Y/N) ; High water) alarm (Y • System type Gravel below pipe 67; i ft2 Monitoring tube I Depression over field ,,Results (Pass/Fail) i, I I For bedrooms 4.14n. in Water added gal. New depth in. Absorption rate > g.p.d. If yes, give date ft. e: I min. Final fluid depth Y rejuvenation treatment (past 12 mo:) (Y/N & type) , in. a 1 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at - er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot �R On adjacent lots /oe "`Fig Absorption field on lot Jq On adjacent Tots /G©'''L7 Public sewer main 76- if/ Public sewer manhole/cleanout - AGO++`,'{ Sewer /septic service line ,e3""`�Holding tank. APR SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 'J/(•C Property line 0 Absorption field Water main ARi Water service line Surface water '`lA Wells on adjacent Tots �1A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0/A Building foundation A' Water main Water Service line�/A Surface water ��� �I Curtain drain Ar, Wells on adjacent Tots AX F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name OorlLc f5 7 Date HAA Fee $ 3 b Date of Payment Coci Q' Receipt Number 3--) 3 (Rev. 12/01) S • Waiver Fee $ Date of Payment Receipt Number Sent By: KENLEY CONSTRUCTION SERVICES; 907 248 5774; Jun -16-04 10:31AM; Page 1/1 '1. • • • •♦ t • / * • • • • . • • 4 • • • i • • /z-3, oo# •,� /JP 77.e r,•„• _ �• ,,�_ b.c..or.Acats.-, .~, ill' ='' }3 t.:, .y� f ./,r{r,� 4..1.1/4 .1 .1 'A. .. /• is /•(;.s• :.•::•/1 • AS -BUILT r. • ,. • • I hereby certify tha I have' surveyed the Igllovring described progeny• .5-44 575 s. vn, /z.1 `1'1l -)J 1? /—! , • Anchorage Recording Precinct; Alaska, and that the improvements situated thereon are within the property lines said do not overlap or encroach on the' property lying adjacent thereto, that .no imptvvemenls on prop- erty lying adjacent thereto encroach on the'prernises to question and that there aro no •soedweyss transmieeion lines or other visible easements on said property except ay indicated hereon• Dated at Eagle River, Alaska -� •' •` • this : �' -•-' day of �!—e � • -.10221- - ROAERT C. JOHNSON--• : SCALE: . Registered Land Surveyor No. 880-L$ 1' a Z.p• Boz 436, Eagle Ricer, Alaska • • ' Phone 094.9343 LO'd £1759406 RP H (Ilea put sluuap WH t+0'6 POOL '91. sun f epsaupoM t -=Disc 7F %-_i )IVI UAL* " fi�`F H WELL LOG. -A well`Iog is required for ail welIsdrilled.-= lt�?l if t _- ince June 1975 For wel]s dr _ r s_: give well depth-Ititleall Iog if aVeilable TIME DATE INSPECTOR THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS TIME DATE INSPECTOR INSPECTOR 1 TYPE`OF RESIDENCE ❑ SI NOLE FAMILY ❑ MULTIPLE FAMILY 2. WATER SUPPLY ❑ INDIVIDUAL El ❑ COMMUNITY PUBLIC UTILITY Connection Verified NUMBER OF BEDROOMS e El ONE El TWO PERMIT NUMBER El THREE ❑ FIVE El FOUR ❑ SIX DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE -DISPOSAL SYSTEM El INDIVIDUAL/ON -SITE ED PUBLIC UTILITY Connection Verified I ISepticTank or CD Holding Tank Size: If Tank is homemade give dimensions: PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4._ DISTANCES WELL TO: MATERIAL 'Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line B. COMMENTS 111•11..w ✓" 3 G APPROVED FOR a BEDROOMS El CONDITIONAL APPROVAL (letter must accom• 'certificate) ❑ DISAPPROVED DATE _ LEGAL DESCRIPTION do, 72-010 (Rev. 3/78) May 16, 1979 THE FIRST NATIONAL BANK OF ANCHORAGE RE: Approval on health form for a three Bdrm SFD Lot 10, Angela Heights S/D MUNICIPALITY O'r ANCHORAGE DEPT. G; : t> MAY ��IVIP.O� 1 RECELVED Dear Dusty, Per our phone conversation I am sending a letter of request to have the health form change from two bedroom approval to a three bedroom approval. If I may be of assistance to you for anything else please feel free to contact me. Thank you Your very truly. C i U0c _03 om= Cindy R. eltin Loan Processor The First National Bank of Anchorage • P.O. Box 720 • Anchorage, Alaska 99510 MUNICIPALITY OF ANCHORAGE DEPARTME`` OF HEALTH AND ENVIRONMEN"- L PROTECTION 825 L Street, Anchorage, Ala.._,a 99501 279-2511, ext. 224 or 225 #1: Time .3n aryl Date -d) -17 InsP chhL4a Date Received: May 5, 177 #2: Time #3: Time Date Date Insp r Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES • Lending Institution Request: Mailing Address: Coast Mortgage Company Post Office Box 1200 99510 • Property Owner: Charles/Jonnie L Jennings Mailing Address: Post Office Box 6247 99502 Phone: Phone: 279-0665 276-7600 • Legal Description: Lot 10 Angela Heights Subdivison Single Family Residence:(x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: • Well System: Individual Well (x) Community/Public System'( ) Permit # Depth of Well Well Log on File (x) Construction Bacterial Analysis . Sewage Disposal System: On-site System ( ) Public Utility (x) Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material . Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line '4Ul 1i"fr'ALI r"r ; :C� MUNICIPALITY OF ANCHORAGE r. Pr �, `. flON DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 r,,, \v O 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: VA_ X FHA____-__._____CONV 2. Property Owner: I;rar I es_L. Jennings and Jonnie L. Jennings Mailing Address: P.O. Box 62117. Anchorage, __AK__.__ Day Phone: 276-7600 3. Name of Buyer: n/a Mailing Address: Day Phone: 4. Name of Lending Institution: Coast Mortgage Co. Mailing Address:P-0. Rm. 1200, Anch.,AK 99510 Phone: 279-0665 5. Name of Realtor or Agent: Anchor Realty __John Estabrook Mailing Address: Phone: 272-.8181 6. Legal Description: Lot 10 Angela Heights Subd. Location:ML Chickaloon Street_ 7. Type of Facility to be Inspected: Well No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served ONE If Individual, depth of well TINEmTOW.IY_ 9. Sewage Disposal System Type of System: Public Utility X Individual (on-site) If Individual, date of installation 72-003(3/76) SW Page ;Two Department of Health and Environmental Protection Request for Approval of Individual Sewer. and Water Facilities Legal Description: '.Lot 10 Angela Heights Subdivision Comments Affadavit Attached: Letter Attached: Disapproved: Date: Department Worksheet: