HomeMy WebLinkAboutNETTLETON LT 4 E2Nettleton
Lot 4 E2
#015-081-08
GRED 'R ANCHORAGE AREA BOR,..1GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME It MAILING ADDRESS e-�:� C_�l /_" PHONe J
LOCATION �—LEGAL DESCRIPTIONLI
SEPTIC TANK:
DISTANCE � y
FROM WELL``/i<� MANUFACTURER_ f<.t,-- MATERIAL
INSIDE LENGTH INSIDE WIDTH
TILE DRAIN FIELD: `
DISTANCE FROM WELL _L ,S _ FOUNDATION
NUMBER OF
COMPARTMENTS —
_ LIQUID DEPTH _ LIQUID CAPACITY GALLONS.
TOTAL LENGTH --_I,. f
_NEAREST LOT LINE_= �> OF LINES '_)L,
NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTHA-2 IN. TOTAL EFFECTIVE
ABSORPTION AREA _ SQ. FT. LENGTH OF EACH LINE
`j-- DEPTH OF FILTER 1
DEPTH: TOP OF TILE TO FINISH GRADEMATERIAL BENEATH TILE_.;f)r_XN. ABOVE TILE_ IN.
WELL: t'
TYPE_ — __CONSTRUCTION___ r <1�1e �Z'� ` DEPTH �` DISTANCE
FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM
CESSPOOL OTHER SOURCES.
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL7Z
LOT SLOPE:
?�
REMARKS:
Form EQ -032
REMARKS
DIAGRAM OF SYSTEM
DATE
DATE CG __-'L(%'ZAPPROVED
G.A.A.B.
i
QWHUVIAI DF O�.. [C—:R i�L 11 A,
DF On I PROP W HEONTI-I AND RNWROFUNNITIL 11TOTE:CT
IRD. 9950
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0: 0 A ITO A tit I W11 E1410.1- FMH) 12001 FJ F OR U1 JOUR. I C WA.K.
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ENS1111-1,111 I ON.
,1: CA I.�!] I F�Y f WiT f 101 IAN I I.J RIO 411 ill 1W IRITILI I fRIOL141 4; IWOR NOS I 1k
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`111F: C:0L'E,:.
SHAND. ...............
--7
Department of Environi� ntal Quality
3330 "C" S Meet
,chorage, Alaska 99503
Performed for Ann Height
Legal Description: East 1/2 of Lot 4, Nec
This form reports: Soils log Yes
Depth
Feet
2 Silty Sandy Gravels
3 _ with occasional cobbles
and layers of Silty Gravelly
4 _ Sands
Moist
6 -
8-
9-
\
10 -
11 -
12 -
13 -
Date performed
!ton Subdivision
ercolatitest
3-30-76
J'J
14 -
- �t e
Was water encountered? No If yes, at what depth?
Reading I Date I Gross Time I Net Time
Depth to M20I Net Drop
,,VF ercolation rale — minute,
Proposed installation: Seepage Pit Drain Field
Depth of Inlet Depth to bottom of pit or trench
,.COMMENTS: -2 2 5 Square_'feet drainage area required per bedroom
No bedrock or ground water encountered
Performed By. CONSTRUCTION `PEST LAB —Certified By: ( f ate:
J mes Mack
BPAI
Municipality of Anchorage
*A.
Development Services DepartmentBuilding Safety DivisionOnsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-081-08 COSA# QSC/O/OSS
Expiration Date: 9 - '�k ?-/0
1. GENERAL INFORMATION
Complete legal description NETTLETON LOT EAST 1/2
Location (site address) 9910 HILLSIDE DRIVE, ANCHORAGE, AK 99516
Current Property owner(s) MADA M. ANGELL Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P21113 as Lii:Ci77:[el� �
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
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, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD EAGLE RIVER AK 99577
Engineer's Printed Name __KENNETII M. DUFFU Date 05/21/2010
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen �r
encroachments, deficiencies or discrepancies exist
6. DSD SIGNATURE
t� Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
.vara t necKnsS x Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory _�� Other
By: k(% Vrorz-�Original Certificate Date: .SO
(Rw. I IM)
Municipality of Anchorage . e .•
• '' Development Services Department y
Building Safety Division
On -Site Water & Wastewater Program ' •' '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: NETTLETON LOT 4 EAST 1/2 Parcel ID. 015-081-
08
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWSID # _ Well Log (Y/N) N
Date completed971 4 est. Sanitary seal (Y/N) y Wires properly protected (Y/N) Y
Total depth 195 est fL Cased to •140'+ fL Casing height (above ground) 24+ In.
FROM WELL LOG AT INSPECTION
Date of test PER 0211987 HAA 5/14/2010
Static water level 171 R. 174 ft.
Well production 4+ 9,p.m, 6.43 g.p.m.
WATER SAMPLE RESULTS:
Coliform _NLG colonies/100mL Nitrate 5.50 mg/L
Arsenio: _ND D mg/I Date of sample: 5114/2010 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Unknown Date installed 06/25/1976 Tank size 1250 gal.
Number of Compartments Unk, Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N
High water alarm (Y/N) N Date of pumping 5/12/2010 Pumper McDonald,.;
C. ABSORPTION FIELD DATA
Date installed 6/2511976 Soil rating (g.p.d.W or felbdrm) 225 System type Deep Trench
Length 35 R. Width -2 ft. Gravel below pipe 10 ft. Total depth 1¢ ft. (bottom of effective)
Eff. absorption area 700 f? Monitoring tube Y Depression over field N
Date of adequacy test 5/17/2010 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test *53.50 in. Water added 850 gat. New depth •77 in.
Elapsed Time: 240 min. Final fluid depth '63 in. Absorption rate >= 450+ a.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date _
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at _in. 'Pump off* level at _in. High water alarm level at _in.
Datum Cycles tested Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot loo'+
Public sewer main 751+
Sewer /septic service line 251+
On adjacent lots 10o'+
On adjacent lots 100'+
Public sewer manhole/cleanout to(Y+
Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas _Loo '+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation _51+ Property line 51+
Absorption field 5'+
Water main ]o'+ Water service line 1o'+ Surface water ion+
Wells on adjacent lots Loo'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1o'+ Building foundation 1o'+ Water main Io'+
Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+'
Curtain drain _50'+ (None Known) Wells on adjacent lots 1001+
F. COMMENTS
G. ENGINEER'S CERTIFICATION +'""Ak�\`
�G. OF At. w
I certify that I have determined through field inspections and /6
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS �� V'
am C�
Date 05/21/2010 �, a�®
yq a�0r"s
COSA Fee $490.00
Date of Payment Sb i fJ
Receipt Number 00 ig' C
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage ..,
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 101055
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
4 East 1/2 of Nettleton subdivision. This inspection revealed a nitrate
concentration of 5.5 milligrams per liter (mg/L) was reported for the
property's well water sample. 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.
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
Well at 9910 Hillside Drive was inspected by camera and no perforations were found
above 44'.
Brian Wille
Aarow Pump R Well Service
I
o
S.
I S 89-56-j2- E 289.96'
_oA (S 89-55,P8" E 290.22' R)
10' UTILITY EASEMENT
a
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SEPTICO• `
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FP CANT °• 1�y IB° ti0y I�/.��.� �y
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GRAVEL
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W W XS
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X-�X—X�X—X�X—X=_$%X'X X %
30' UTILITY EASEMENT 50'
I
—�V S89.55'00"E 290.20' (290.28' R)
BASIS OF BEARING
I
I
FND 510
ANCHORAGE RECORDING DISTRICT, ALASKA =
O =FND 5/8" REBAR REBAR
ASBUILT OF: O = FND V IRON PIPE
NETTLETON SUBDIVISION
EAST 1/2 OF LOT 4 PLAT P440 GRAND
SURVEY CERTIFICATION: 1, John L. Schuller, have conducted a
OF A� \\ ��lOtil� LAS S•
physical survey of this property as shown on this drawing and that the /� PxS •"" 9s1� �g pf
improvements situated thereon are within the property lines and no 4 ;!N'
enchroachments exist other that noted. C 49THYI,� W a x�
......
EXCLUSION NOTES: It is the owners responsibility to determine the / f `
existence of any easements, covenants, or restrictions which do not l
appear on the recorded subdivision plat. Under no circumstance should �I IOHN L SCHULLER.: / s4
any information on this drawing be used for construction of fences, '' &I '•,• IS-10408 ...r°/
structures, improvements, or for establishing boundary lines. (lap�'S�J51 J•O'' �a � 212 East 51st Ave.
99503
WINK ORDEN NUMBER. DALE: SCNE: -MNL' \\�o /e9 �1on0t �•°� Anchorage, 22, 1455Alaskoffice
MAY 15, 2010 1"=40' ' (907) 227-1455 office
10-015 ANN er. aE0{ED By cam NumuE - eoa AC (907) 868-3793 fax
JLS 2439 1 100128
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date February 5, 1987
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, towns
hi , range)
E -11 lot 4 Nettleton Subdivision ! 1;70 11.
Location (address or directions)
Off hillside Drive
(b) Applicant Name Eric Worthington Telephone: Home 346-2490 Business --
Applicant Address 9910 Hillside Drive, Anchorage, Alaska
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder M ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
7alcnhnnP
Telephone
(f) Mail the HAA to the following address:
Eric Worthington
9910 Hillside Drive
Anchoraze, AK. 99516
2. TYPE OF RESIDENCE
Single-FamilyAN Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well KX Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ZX Public ❑ Community ❑ Holding Tank EI
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 2-025 (11,84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Whitewater Engineering Telephone 345-7008
Address 11600 Cange Road, Anchorage, AK 99516
Date February 5 1987
6. DHEP APPROVAL
Approved for
Approved
AV
v 4!T ...... .
Engineer's Seal
�... ...
THCht A. FISCHER !�
�a �•. CF -6793 .••rte>
fh�re (3) bedrooms by jr," Date
v'
Disapproved Conditional
Terms of Conditional Approval
CAUTION
2 —10 —'s 77'
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (ivea)
MUNICIPALITY OF ANCW 3E
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
E B !-) 1987!
RECEIVED
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (MAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: k � Lot
Nettleton ubdivision
Well Classification . Private If A, B, C, D.E.C. Approved (Y/N) N/A
Well Log Present (Y/N) no Date Completed Est 1974 Yield 4+ GPM
Total Depth Approx 19-tased to — Depth of Grouting NIA
Static Water Level 171 — Pump Set At Owner Says 187'
Casing Height Above Ground 2411 Sanitary Seal on Casing (Y/N) yes
Electrical Wiring in Conduit (Y/N) Yes Depression Around Wellhead (Y/N) no
Separation Distances from Well:
To Septic/Holding Tank on Lot 100"0 ; On Adjoining Lots 100•0
To Nearest Edge of Absorption Field on Lot 1004' ; On Adjoining Lots 100.0
To Nearest Public Sewer Line _NSA To Nearest Public Sewer
Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot N/A
Water Sample Collected by Roy D. -Lnman ;Date February 3, 1987
Water Sample Test Results — Satisfactor
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 6/25/76 -Size 1250 No. of Compartments _ Unknown LVu
Standpipes (Y/N) Yes Air -tight Caps (Y/N) — Yes Foundation Cleanout (Y/N) s2_ '
Depression over Tank (Y/N) No Date Last Pumped November
Pumping/Maintenance Contract on File (Y/N) NLA - ; for N/A
Holding Tank High -Water Alarm (Y/N) N/A _ Temporary Holding Tank Permit (Y/N) NA
Separation Distances frorn Septic/Holding Tank:
To Water -Supply Well 100+' To Building Foundation 10+'
To Property Line _ 100+' To Disposal Field —.5 '_
To Water Main/Service Line _ 2 5+ To Stream, Pond, Lake, or Major Drainage
Course 100+'
Comments As Built does not speci
Page 1 of 2
72-026(11/84) _.
number of compartments,
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 2�5 Type of System Design Trench
Date Installed June 25 1976 Length of Field 35'
Width of Field 36" Depth of Field 60
Gravel Bed Thickness
Square Feet of Absorption Area 700' Standpipes Present (Y/N) Yes
Depression over Field (Y/N) NO Date of Last Adequacy Test February 4, 1987
Results of Last Adequacy Test Satisfactory
Separation Distance from Absorption Field:
To Water -Supply Well 100+'
To Building Foundation 20+'
Lot IN /A
To Water Main/Service Line 50+'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
" Pt rnrr_On" Level at —
High Water Alarm Level
Tested for
Electrical Codes (Y/N)
Comments
To Property Line
20'
To Existing or Abandoned System on
On Adjoining Lots ..
To Cutbank (if present)
r
Dimensions
Manhole/Access (Y/N)
—
"Pump
Off" Level at
s _ Vent (Y/N)
20'
Pumping/Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request'*
I certify that Ive che=Z;2:-2�te
d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed February 5, 1987
Company aNIOA No.
/U �� UUS ��A4
Receipt No.�l� (��0- = ��R@
Date of Payment %� ��',♦.••' A • `• .®®
V Uy � -`: j� 0 Engineer's Seal
Amount: $ �0
I'
a...,. ,.. :. ..�
THOM A. FISCHER
Page 2 of 2 CE - 6793 Ir
o� �0-
�
72-026 (11;84) ��'Vk�f� N�^�`40.9
JML LABORATORIES, INC,
LABOP'"9RY I.Q. 0
71.27 ULD SHARD HIGH% N
ANCHORAGE, ALASKA 99518
(007)344-8551
.Y
BACTERIOLOGICAL WATER ANALYSIS
TO BE COMPLETED BY WATER SUPPLIER
FOR LAB USE ONLY
DATE COLLECTED
! TiF1E COLLECTED
TYPE OF SYSTEM
_
MONTH RAY YEAR
❑ IC INDIVIDUAL
❑ RESUBMIT SAMPLE
PM
Sample rejected because:
'--'�"-----
I.D. NO. (PUBLIC SYSTEMS) CIRCLE CLASS
CHECK ONE OR MORE
Lei ' _ I A B C Residential
❑ Sample too long in transit.
NAME OF SYSITEM TELEPHO/N/E NUFIBE('
/ �hk-e
Sample should not be over 30 hours.
cwt ' ) '4— `� �r/' !. �� `�
❑ Sample received too late in week
SYSTEM ADDRESS
'
❑ Not in proper container
❑ Leaked out
❑ Insufficient information provided.
CITY STATE ZIP CO['I
Please read instructions on form.
LOCATION WHERE SAMPLE WAS COLLECTED
❑ Other (Specify)
�COLLE TED BY:(SIGNATURE)
RECEIVED FROM
TYPE ;GV SAMPLE
RECEIVED BY
(CHECK ONLY ONE THIS COLUMN)
PATE ... ��' TIME...�.�:
❑ DRINKING WATER ❑ CHLORINATED
ANALYTICAL METHOD:
VCHECK TREATMENT ❑ FILTERED
,UNTREATED OR OTHER
® MEMBRANE FILTER
❑ RAW SOURCE WATER
❑ FERMENTATION TUBE
❑ NEW CONSTRUCTION OR REPAIRS
❑ OTHER(Specify)
Date & Time Started 21-5"AL 7 'Z. C=�+rUS
pate & Time Completed4/� 7 oi'ay S M
IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON -CONFORMING SAMPLE?
❑ YES ❑ NO PREVIOUS COLLECTION DATE
ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM)
LABORATORY RES L
Analyst C T G e
❑ Other Bacteria
❑ Test unsuitable because:
SEND REPORT TO --(PRINT FULL NAME,,ADDR�ESS AND ZIP CODE
NAME L G w `e l
// ^ J // /
ADDRESS ! - 1����1��
❑ Confluent Growth
❑ TNTC
e
j
CITYSTATE ^c_
Z - I// � ZIP l% "�j `'
SATISFACTORY UNSATISFACTORY ❑
BACTERIOLOGICAL WATER ANALYSIS RECORD
FOR LAB USE ONLY
TOTAL COLIFORMS Membrane Filter:
Direct Count Coliform/100ml
Verification: LTB
CJFECAL COLIFORMS
BGB
Final Membrane Filter
Results _ Coliform/100ml
ElOTHER Reported By
_ Date _
Time _ AX
P.M.
READ SAMPLE COLLECTION INSTRUCTIONS ON
BACK OF FORM
D f1�A1/1T ��I%B
�f�r% A Flll ♦��y
HOME SERVICES
15900 Francesca Drive
Anchorage, Alaska 99516
545-1890 or 545-2444
CUSTOMER
1, Ie <<7 orl;l+)t'.lott z aa' V_
Block Lot
Fl
DATE DESCRIPTION
INVOICE # j .•_'
AMOUNT
TOTAL
REMARKS
7—
Gallons I Septic Cesspool Standpipes `Time
❑ PROBLEM AREA—CALL FOR MORE INFORMATION
❑ NEEDS TO BE DONE AGAIN IN 6 MONTHS
/M Good Shape ❑ Sludge buildup on bottom ❑ Floater on top
❑ Jim cap missing or ❑ Cut standpipe to 1' above ground ❑ Needs Septictrine
needs replacing
,\
PLEASE PAY FROM THIS INVOICE—
Departwnnt O'f -4041t1h A -ad
Envim"Im"11ta-, Protection
2510 gaot Tudor Road
AnChf);Caye, AD-toka 0!4507
276-22 1.
March 4 1976
5736 vavlclifP nrive,
Anohoragef Alaaha 59504
vlwbjoct. ; ZV� Lot 4 Ntettltlton 3ubilivioiu-n
Dear ;Ar. ;Utul-.
Tim -1 health 1,040- �t LhjecL property rovealed tlw 'location
.i of 'ho, ow.
of ' -40 seeipag"A !.:At WAs U-0riloWn. A1,F;Q, iii f:TUO-ation im thtf� Sc1qitil"t
tank CAPAf Ity. sifloo the SOWL140 nenspaiu �)it location was tiWknown
the dist anc between, Wit- 'ooll, and rarer jyotemi roymins a Cru"wtioll
as to tho 100 foot. w4paratiou rociulroment,
Thif, dopartment cannot mmko it dotn-rmillatJOIA -until furthor
in rivailablo.
Plcm-np comstmwt, this U -MOO At YMIr 03rlie,-31t, conwniomvzo earr,�
lucorkqatiox) You pla.y I -lava.
"roll
J -P
April 5,,, 1976
4 te
.Mr. Thomas 'Utal
5736 �!-rvlcliv-f *.vivo
Alaaka 9�1)5t)4
t Wi Lot 4 -Az'tkttla
Goer Mr. Uitot %
Th -e say.tic
a'
ron in
,
'C' F G-2221
411
Tht
al 0 1)
to install a now. a., qorption-- tronoll
-ioe V)7'
If you 4mrs alm)r further que-ad'onof
a -L 27r ... 22,21, 113.
sinricireely,
U, !3UQhlAcjlz
— A
MUNICIPALITY OF ANCHORAGE 2
DEPARTMENT OF ENVIRONMENTAL QUALITY Por,
3330 "C" Street, Anchorage, Alaska 99503 — 274-4561v b—L) 64
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
CMRO VA _
FFIA
_ CONV NX
2. Property Owner: Thomas B. Hite and Ann L. HIte
NETTLETON SUBDIVISION
Mailing Address: 5736
Radcliff Dr.
Day Phone
349 4792
3. Name of Buyer: - Eric L.
Worthington
off
O'Malley
Mailing Address: 9870
Hillside Drive
Day Phone
272-4441 X 60
4. Name of Lending Institution:
National Bank of Alaska
Mailing Address: P.O.
Box 33859 99501
Phone 279
2506 X21
5. Name of Realtor or Agent:
Petro Realty
Mailing Address: Corner
Northern Lights & Fairbanks Phone 277
4182
Please contact realtor
for arrangements for water
sample
6. Legal Description: East
1/2 of
Lot
4,
of the
NETTLETON SUBDIVISION
Location: Hillside
Drive
off
O'Malley
Road
7
a
Type of Facility to be inspected: SFR
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation House was built about
v- No. Bdrms. 3
Individual XX
1
EQ -037 (1/74)
Individual (on-site) XX
4 ,Vt%o A62 APfA
7
G
y
s GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
�`k'AJPfO JApUA0.y ''' 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 23, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR / I/�QS
Conv.
1. Approval requested by: National Bank of Alaska r -Am
Mailing Address.. Post Office Box 3-3859 Phone: 279-2506 x 21.
2. Property Owner: Thomas B. & Ann L. Hite Phone: 349-4792
Mailing Address: 5736 Radcliff Drive
3. Legal Description: Hast 1/2 of Lot 4 Nettleton Subdivision
4. Location: Hillside Drive off of O'Malley Road
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data: :Individual
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On-sir.e system (house was built about 1962)
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank Absorption area Sewer Lines
Nearest lot 'line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages - Re st for Approval of Individual ar & Water Facilities
Legal Description
Comments
ApprrovedW�iti`t,4 Disapproved _ Date
Appr�al,Valid for one year from date signed
Greater Anchorage Area 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)