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HomeMy WebLinkAboutNETTLETON ACRES #2 LT 12GRE,,,ER ANCHORAGE AREA BOk_dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska ggS03 , INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM - ..~_ . .......... ~;~ .... ::,:-,:-.---- --, ~ - ._. LOCATION ~'lO~'}~'~g"~m~"l'~ I~,/ LEGAL DESCRIPTION L-(J'~' /'~-- ,~/,~-~TL{zT~)'~l f..~(-~,~7~ ~b,~)/:J:-~_ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH NUMBER OF COMPARTMENTS '~-~-' LIQUID DEPTH LIQUID CAPACITY/~¢jCj GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL '~-'-/0,-~ NUMBER OF LINES ABSORPTION AREA ~'''~Oo''q FOUNDATION DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LE NG T H.~,~_ NEAREST LOT LINE .OF LINES TRENCH WIDTH f~IN. TOTAL EFFECTIVE MATERIAL BENEATH TILEC.~.~ _IN. ABOVE TILE ¢ IN, WELL: TYPE BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION ___ DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE____ TANK SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: ~-~ SEWER LINE DEPTH: -- pi pE MAT E R i AL: ~--~,'~'-E~'~ LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE'7~/t4)'''1 APPROVED J2, C-'- ~/~I----~~ G.A.A.B. Form EQ-032 I ~lr,} I'"I!i!i'. liii;'FIE I:::i D 'i' I:;~: I:::l :[ I I..xii.2 I",II!ii/t-T'l.l::'l"EIl'.,I i:,:lE:l~i:tiiii:!i!; 'TI"IIE I..EH(¥TI-I I;;:, :[ I'll:il;l'.,l:i~; 3; OH :J; :E:; "i'HI::!Z i .t!i:l",{Ei"t"H ,.'.' ;I; I",l I::'{i:IET ::, I;:tl::' 'i'I";E; 'l'l:;i:l~'::l",l(;::l.-.I Oi:;;: I::.',I',i:FI :l: I",1!::: ;1: I!!i:i..E:,. "i'l-'lf!~ l:::,!i!;l::'"i"l"l Ed=' I::! "i'l:;i:l!ii:l'.,IE:l-4 EIt;;i: I:::'];T Z::!i; TIllS: [)];:ii;TI=INE:IE E',I:!:'IHI!;;IEi',I "l'l"lJii; :i:;I..ll:;i:F:l=l(;:i~i; GI:;;:EIi. It'.,IE:, FIND 'Fl..Iii: E:O'I'-I'OI"'I I;)t:::' 't'l'lli}!; liiZ;:.::(;:l:::l'v'FIT;I;I;;)l',! ,:.];i",I 'i'HiEl:;i:liZ :t:::i}; I",10 '.~i;I.}i;'i" I.,.t ;i; [)TH I:::'l;Zll:4'. THE I;3Fi:I:::I',,,'I:{L. [::,l!i;F:"lq-I ;!;:i~; "I'HIE t"'l;!;t'.,[:fZl"ll.ll'l [;:,l!ii;I;:"l I"1 O1::" tZ:i!:;;:l::i',,,'li!!Zl.., li!:li:i:"ll.,.ll~;[i};t'.,! 'TILE: I::fl",ll;::, Fl"llE t3OI'TEd'I Ell::: 'TI-IE I ;i; ;:-:: C FI ',,,' FI i ' ]; ON ,:: ]; I",! I:::lEl:ii;'l ;:,. I!!:l:::ll:;;:l{l::: ); I.J. :1; I".!G E i:::' I:~l',!"r' ii!;"r':ili; I'1!!!;1"'1 t.'.1 ;[ 'l Ir'll:;)l...IT I:::' ;1; NI=II.. '[ N::~;I::'I:iZE:'F ;[ ON I::ll'.,llZ;:, I I I II 'TH ;I; I I .I t. I I II I ,t I.,.I ;i: L.L. t!i~l!!!Z l!i!;I...lli?,..;fli!:E:T 'T '/I l:::'Fi:El:i~-;liiXZ:l..l'T :[ Ol'.,I. Juno 6~ 1977 S -;~ovo gyverson .qtar Rout~ A Bo~ ].581B Anchorage ~ Alaska 99507 S'ubj eat-' P~rmit E×pJ.ration 3% per~'4it issued by tht~: department for well and/or on-sit~ sewer ~.ns,~.all~t3~on on I,ot .]..~_ and Lot 13 Net~l~ot! ~%~res Stlbdivzsion tt~:t~ e:~l)~red sznco the m~sue date exceeds oho (t) ]in tho (~vent you still plan to install the wol! and/or on-~lit¢~ sewel~ syston%, a new permi% is required, ~:he orif[ina! soil Bast may be used to obtain a current pernito Xf fha well ha~ bc~en dril!od, a well lo{[ should t,o sent to 'this d~part~ent to :iocu~.~ent the insta].latio~ da~ho. If you h~.~w~ any questions r~gardin[~ th~% above mattor~ please do not hesit~J~e to contact this office im~:'~di~tel, y at 279-2511, extension 224 or 225. Sincerely, F EF:.I] I 1 NO. LGCR'TION HOMESTEAD TRAIL,' L. EGfiL L:t2 NETTLETON ACRES SUBD L. OT '~-];I;~..F.. TYPE OF ~-' '~' ' ' -U.[L FIL:,ORB~ION SYSTEM [S: TRENCH ~., PIAX!MUF'I NUMBER OF BEDROOMS = < SOIL A ~G ~](SO F I,,8R.~= 85 TFIE RErS~IJIRED SIZE OF THE SOIL ABSORPTION SYSTE]['I THE LENGTH D[NEN~ZON ZS THE LENQTH (%N '[~EET:~ OF THE TRENC:FI OR E:,RFIINFfE:ll). THE I)EPTH OF A TRENCH OR PIT ~S THE: DZ.ST~NC~ BETWEEN THE SLIRFACE OF THE GROUND HND THE BOTTO~ OF THE EXQHV~TZONx (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMIJM ~DEPTH OF~ G~'fi'./EL BETWEEN THE OUI'F'RLL.. F'Z F'E FIND THE BOTTOM OF THE EXnRVRTZON "(:ZN FF'~T~ ' FE~ E: [~ !_,t ~ t~ E [) ~ E F~ T · ~ T' ~ N ~=:: E;fiCI<F'ILLING OF fiNN' SYSTEM HITHOUT FINAL INSPECTION AND FIPF'ROVFtL B'T' TliI:E; DEPfiF',TMENT HILL BE SUBJECT TO PROE;ECIJTION. 5'&45.F.~ SE:!I,JARE FEE]" MINIMUM DISTANCE BETWEEN fl HELL AND ANY ON-SITE SEWAGE DI_C:F'CISfiL SYSTEM iS ±00 FEET FOR tR PRIVATE WELL OR 200 FEET FOR A PUBLIC NELL. HELL LOGS ARE REQUIRED AND MU-qT BE RFTURNED TO THE DEPARTMENT WITHIN 3:~,:] DFIYS OF TWE WELL COMPLETION. SPECIFICfiTIONS fiND CGNSTRUCTION DIAGRflNS ARE AVAILABLE 'l"O INSURE PROPER I NSTALLAT I ON. I CERTIFY THAT ~: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AN[:, WELLS FLS SE7' FORTN BY THE MUNICIPALITY OF' flNCHORRGE. 2: I HILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. ~:: I UN[)ERSTRND THfiT THE ON-SITE SEWER SYSTEfl MAY REglUIRE ENI...RR[~EMENT IF THE RESIDENCE IS REMODELE:D TO INCLUDE MORE THAN ~ BEDROOMB. S I GNED: -APF L I CI~F~n" S]~/E SYVERSON ............. Certified Well - ~izeofcaslng-2t~ T~a~' - ..... .--.,..,,.....,,,,.,.,~; ....................................... ~ Distance to Wa~er ~k~ ~i ' ' ' Distance ~o. water While pumping ........... :...9.9.._'.~.e.~Jl...:: ........ :.-:....:..-:. al ~ate. .o~ :_ -.1-a'O.Q: .: .... :...~ ganons p~ liou'r .:x ........ ; ...... e · , - ~e above t~ue and Con'ec~ ' ._ i'" Driller' FOSS .DRILLING 133f~ INGRA PH, 279-2849 ANCHORAGE, ALASKA 99501 We advise you ~o a~tach this certificate to Your deed. W.O. ~7929 June 17, 1975 DO",':L ;~ ~ · ~ ,~r.9 4040 "B" S~,.o~.~,- Aac~ ( .... \,,;, AK Attn: A. Lahp. um Subject: Nett].etoh Acres, Soils Ge ~, ti en',c:n: at tho reqt:est'ed ]oeaUJ.ons for e:,:a:::ina~ion of the soils for OR--S'" ' ~ ..... N. systems l~e individual so',..'ace trea ....... . . - The ho]_es t,;er,:: p!acod :~-',,: .... ....... ....,¢,,L...::; .,? {'. ~0¢ .... "~o ..... ...... ,:',ce w!":'~., ~ ..... Anchol?ac:e Area ~ '~ ' l' ~o~..ug~l Pepa]:tmont of m .... . ....... ., i ....1).o~..u~ta Qua~_~... ~ u'-'~' criteria. The t:eskhole ]ocati. r~r~,s a::e shov,'a on fig. 1, Standard e:,:p!a]',ahery i:-:fo~'::natio2, en sheets 1 to 3. The C-AAB p'ubli'shc, d corrc!ation og soil kextuA'al t',':;es by tzhe Unified Class ....... t ........ /..,tom in ~.o - ~ ; c4.-- ,-4,~,. "i ~ ' ' ' terms of .' :uaze gee" o~, seepage area pe~ bed:looms 4s as follows: Un i .[ i od Soil Class Seepage Area in Sq ft /b~s ..... ~, GW 85 GP 85 G:'I , 225 S','¢ 2_25 SP 150 ""' 250 bi 275 Cf', 350 Ct! 350 DO',-.' I, F, ng inter :; AL{.~: A. June 1'?, 1975 Page 2 Soil wi th sec,-"~'~ ......~n _...c ..... 250 .:,~.:. ~t/bodroom are soemaqe oil .... ct. to DO abovc thc ;,,'ator tab} e. areas de:scribed hv ti~e several test hoAes. D{'pth in Neet Seepage Are?. in Sc/. Ft./.r~edrooms 10 1! 1.3 1,1 20-9.0 90-110 15-1.20 1.20-!40 1 5-!_4 0 ]. 5-140 2 5-32 0 .1.2 0-14 0 ] 0- 6,0 60-8.0 8 0-13.0 30-7.5 7 5-11 0 1 ] 0-14 0 25-75 7 5-12 0 12 0-14 0 1'3- 4 5 4 5-11 0 ll 0-14 0 2 0-14 0 1. 0-!,; 0 3.0-].,; 0 O. 5-10 0 10.? ! .; ~0 1.0-13.0 13.0--14.0 85 200 85 200 85 85 85 125 85 200 250 85 200 200 200 200 200 85 200 250 85 85 85 125 85 125 Tl~e o~l7 free w~:tc'r cnccu::t:ered was be.low 9' in hole 'J'hJ:; ap:~eared to bo the ]<.w :)oint i:; ' ~',~ area. Ev(2:~ in '~'-'- ./ / 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 GENERAL INFORMATION Complete legal description Lot 12 Nettleton Acres Subdivision No. 2 Location (site address or directions) 6730 Paula Place Anchorage, Alaska 99516 Dave a~d EleaLnor Jacobson Property owner Mailing address 6730 Paula Place, Anchorage, AK Lending agency Mailing address Agent Ad dress Day phone 346-1042 ~k. 99516 346--3337 bm. Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 -"1 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 Holdin9 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) Fronl MOA ¢21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows 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, lfurtherverifythatbased 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. Gilfilian Engineering, Inc. Name of Firm Address 255 E. Fireweed Lane, //102, Anchorage, AK Engineer's signature /,~'1~'~//~/~ Phone 995O3 DHS SIGNATURE Approved for '~7,,,¢~_.<_ ~),×_ bedrooms. Disapproved. Conditional approval for 277-2021 10/26/92 Date ~' - ~ ~ :~''~ -'. - bedrooms, with the following stipulations: Additional Comments By: 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.  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 12 Nettleton Acres #2 Parcel I.D. ~ /lC'- A. WELL DATA Well type Private Log present (Y/N) Total depth 173 ft. Yes Sanitary seal (Y/N) If A, B. or C, attach ADEC letter. ADEC water system number h~ Yes Date completed 7/25/77 Driller Foss Drilling Date of test 49 rt. Static water level Well flow 20 Pump level Unknown Cased to FROM WELL LOG 7/25/77 173 ft. Casing height Wires properly protected (Y/N) 1.1 ft. Yes AT INSPECTIONMUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION 9/18/92 55 ft. g.p.m. 4.1 Unknown R.E .EIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 118 It. Absorption field on lot 130 ft. On adjacent lots Over 100 ft. ; On adjacent lots Over 100 ft. Public sewer' main Sewer service line Over 100 ft. over 100 ft. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate Date of sample: 9/18/92 Nitrate 10/12/92 Bacteria over 100 ft. Public sewer manhole/cleanout Petroleum tank over 25 ft. q_~¢~, O¢ Not Detected (O.lmg/1) Other bacteria 4 colonies/tOO ml Collected by: Robert S. Gitfilian SEPTIC/HOLDING TANK DATA (Septic Tank) Date installed 7/12/77 Tank size 1000 gallons Compartments 2 Cleanouts (Y/N) Yes _ Foundation cleanout (Y/N) Yes Depression (Y/N) No High water alarm (Y/N) NA Alarm tested (Y/N) NA Date of pumping /0--,-23 - q~ Pumper ,'~o7-d'- ~o(~ ~-,~,~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 118 fti Over 100 ft. 25 ft. Well(s) on lot On adjacent lots Foundation To property line Over 10 ft. Absorption field 10 ft. Water main/service line Over 25 ft. Surface water/drainage Over 100 ft. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION NA Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles 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 (* Int`ornatio~ obtained t`rm lvD^ records. ) Date installed '7/12/77 Length Cz 22 t`t. Width * 4.0 £t. · 286 st' Total absorption area None Depression over field (Y/N) Results (pass/fail) Pass Soil rating Gravel thickness * 6.5 ft. Cleanouts present (Y/N) Date of adequacy test for 3 Peroxide treatment (past 12 months) (Y/N) * 85 sf/br System type * Deep trach Total depth* 7.0 ft. Yes 10/23/92 bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 130 ft. To building foundation 40 ft. On adjacent lots Over 25 ft · Over 100 ft. Surface water Curtain drain Over 25 ft. On adjacentlots Over 100 ft. Property line Over 100 ft. To existing or abandoned system on lot ~ Cutbank Over 25 ft. Water main/service line Over 100 ft. 40 ft. Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Robert E. G~filian Engineer's Name Date 10/26/92 HAA Fee $ /"~7'~) Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 10/13x92 15:4~ ~ 90? 37~ 5686 GILFILIAH EHGR P.O1 MAT-SU TEST LAB Soils - Concrete - Water Field and Laboralory Testing Services $7~f Maytlowor Ooua, Wasllla, Alaska 90054 - 7880 Phone (~0~') 376.3005 Fro((9{)7) $Z$.5600 J~[!J~dIN_~_.._VV. ATEI~L ANALySIS_EOB TOTAL., COLIFORM Name:._. ~ ~_6-~¢., 3~c~¢$~..~ M~)lllng Addre~a:~_4~{r~ , ~ ..~... Semele Infgrmation Lager Desm'iption:~ ~ot' Date Colleoted _~/~ ~,/ 3 ~,~ Sample Type: .~_Routine Time Collected: __Repeat Sample # Phone: _~'.tG .. /c~.q z PWSID No; o~3;' Rio. I qz.}l[ Collected By: ~ce~ ~'. G~c£~(,~ ~) __Treated ~_Untreated __Fecal MAT-SU TEST LAB Soils. Concrete - Water Field and Laboratory Testing Services 5751 Mayflower Court, Wasilla, Alaska 99654 - 7880 Phone (907) $76-$005 Fax (907) $73-5686 CLIENT: Gilfilian Engineering, Inc. ADDRESS: 255 E. Fireweed #102 Anchorage, AK 99503 PHONE # 277-2121 ACCOUNT #': 001 DATE: 09/21/92 COST OF TEST(s):. $22.00 PAYMENT: CHECK # CASH REFERENCE NO: 392307 TESTING REQUESTED: Nitrate LEGAL/PROJECT NAME: Lot 12 Nettleton Acres //2 (GEl 192111) PRIVATE: X PUBLIC (LIST STATE ID NO.): DATE RECEIVED: 09/19/92 TIME RECEIVED: DATE SAMPLED: 09/18/92 TIME SAMPLED: __ SAMPLED BY MSTL/RSG Analysis Performed: Level Detected MCL Nitrate ND(O. 10) 10 mg/I mg/I = milligrams per liter ND = none detected MCL = maximum contaminant level NOTE: This analysis was performed by: Mat-Su Test Lab If you have any questions concerning the above results, please call me at 376-3005. Cheryl Fultz, Water Lal~Qlanager~ Date ~ [] '- o 0 m -< Z 0 ,? 0 > rn ~ :~ Z rll > ~ IO 0m ~I ,C'T) CHEMICAL & GEOLOGICAL LABORATORY 6~33 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (B0?) $02-~343 FAX: J~vsog~.530~9~. Municipal~ty of A,r~chotege Drinking Water ,.Analysis.Rep_o..~. for Total Coliform B~ece{e~I~'th &'Hl~,~,Serea-a~ PUBLIC WATER SYSTEM LD. # (. .) Z PILIVATE WATER SYSTEM , ---'~=~"-'~i~,ffi~'~~''~;''''' ...... Phone No. MMLing Address City State Zip Code Sample Date:(mm/dd/yy) ~ ~/L!/~7_ . Sample Type: ~2~RoulJne __Check Sample(for routine sample with lab ref. no. ( __Spectal Purpose SAMPLE LOCATION Comments: Time Collected _Treated Water Untreated Water Collected MMO-MUO RESULT: Total' Colifoml SaSla shows this Water SAMPLE to 1~: _ Unsa¢lffactory ~ 8ample too long in transit; sample should not be over 30 hours old at cxtunlnattou to inddcate reliable restdts. Please send n~w sample via special delivery mail. Date Received: t/ J/-}[qZe Time Received: I ~- Armlytlcal Meth~: eMembrane Filter MMO-MUO Date am¥1sts began: [( ~ ~ ~-~' Lab Ret'. No. Re.,mlt* ACtOr 21107'/ * No, Of ¢olonics/lO0 ml, BACTERIOLOGICAL WATER ANALYSIS RECORD E. colt READ I~STRUCTIONS BEFORE COLLECTING SAMPLE TNTC = Too Numerous To Count OB "Other Bacteria Membrane Filter. Verification; FLrml Membrane Filter P,~sul~. ~ He~d For' COn~ltmati°n Direct Count ~ Coliform/lOOml Time Member of tho SOS Group (SocietY' O~nt~r,le de Suwoillan¢O) ~/~ CHEMICAL &..GEOLOGICAL I_ABORATORY . 5633 B STREET ~ALASKA 99518 TELEPHONE (907> 562-2343 FAX: (907) 561-5301 Drinking Water,Analys!s Report for Total Coliform Bacteria C6MPLETED BY WATER SUPPLIER TO BI~/20MPLETED ~3Y LABORATORy - PUBLIC WATER SYSTEM LD. # ( pRIVATE WATER SYSTEM t..~;;~,W#l,i,,., ...... -- . __ Name Phone No. Mailing Addre~ City State Sample Date:(mm/dd/yy) __/l//z/c} 7_ Sample Type: ~x~._Routine __Check Sample(for routiae sample with lab mi.,no. (= __Special Purpose Zip Code SAMPLE LOCATION Comments: _._Treated Water .) _Untreated Water Time Collected Collected By ~t~sIsYsis shows tiffs Water SAMPLE to be: atlsfactOry _ Unsatisfactory __ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. I1[ l V-lq - Time Received: Oq, ~ ~5 Analytical Method: Membrane Filter MMO.MUG Date anaylsis began Time ....... Result* Analy~st 211137 * No. of colonies/I00 ml. BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG RESULT: Total Coliform E. coil READ INSTRUCTIONS BEFORE COLLECTING SAMI~LE 7WTC = Too Numerous To Count OB = Other Bacteria Membrane Filter: Direct Count __ Verification: L$B Fecal Coliform Confirmation Final Membranr~ fr Res~ ~eported ~y 7~ / / ~' Coliform/100ml BGB Date Time ColiformYl00ml /f-/~ ~gz~ ~ S~-~ Member el' the SGS Group (8ocl6t~) Gen0rale de Surveillance) · O( 00000000000000000 00000000000000000000 Ot~: S [ c~:i_i, t-Egg I DATe: RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE INSPECTOR INSPECTOR ~'; INSPECTOF}/~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'~L~' OF HEAL[ii 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P;~QI'ECTION (,k~"~-L~/~/I ENVIRONMENTAL SANITATION DIVISION 8 198] Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1. P/~OPERTtY OWNEI~ MAILING ADDRESS PROPERTY RESIDENT (If different [rom above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION I PFIONE I MAILING ADDRESS 4. REALTOR/~ENT . , PHONE MAILING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBER OF~BEDROOMS ~} One [] Four [~ Two [] Five [~ Three [] Six F-] Other__ 7. WATER SUPPLY ~x~ INDIVIDUAL~ COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG; A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE"* [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE E~ 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 [~ INDIVIDUAL/ON -SITE DATE INSTALLED F~PUBLIC UTILITY -'~ Connection Verified INSTALLER []Septic Tank or E~] Holding Tank Size: r~)C)0 if Tank is homemade BOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~APPROV ED FOR "'~ BEDROOMS E~] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE B Y,,~ 72-010 (Rev, 6/79) Hay 26~ 198] Curl I)awley % Rhodi Karel!a~ 724 l,;ast; 15[-_h Avenue Anchorage ~ Alaska 99501 Subjc;ct:.: I,oi:: 12 Nel:t].eton Acres Subdivision /,unr'oval for t:he individual ...... oewc. r and waiter f¢c.].Lh.]c:o-' i "--' ~' Ca~'ll9<)t5 be S~rar~t:,:~cJ uNkil], hbo .L-O] ..O~lng it:ems have be.a compleLed: , a~ff (i) The ou'bs[de fauceL ho the ves:idence was nob work.lng ~ ~'-~I~ / at-: the t:irne of Lhe inspeckion, Please call this off'ice for at,ether appointment. The sept:'ic 'hank ])umped wii:h a receipff submit-Led to hh:is office, there are any further questions pl ..... e cai]. this office a{: 264--472()., oJ rlc(]rc].y, Rohert C, l?]lah Associate Spec t'IUN!CIPA(.IIY Oc ANCIIORAGE DEPARTNEFI. ,)F :II!AL. TH ^NJ) ENVIRONt4ENI 825 .[, Strceu A~chora~cr,.. Alaska 264-4'22O 'PNO-[ECTlOi;lO~![~099501 R,...ct. I_v.. ~: November 21,_ 1977 RE(.UES]. FOR APPN()VAL OF i/NDJ. VtDUAI', SBWER AND N/','.['EP, J?ACIL,'I'Pt.J,;S Mailing Addre,;s: Pouch 7-007 99510 Ph©nc.~: 279-7511 2~ Pz~oper'ty Owner: Mailing Address Stephen Syver son Pl~one: 344-8549 Legal Description: Lot 12 Block 2 Nettleton Acres Subdivision 4: Single F~}mily Residence: (x) Number oL i-3edrooms: .... ?~_.~3 .... 5, Well System: IDdivJdual We].l (x) Conmmnity/P'uh,].ic SysLem ( ) Permit , Dopth ¢)l[ Well Well Log Cons{:ruction Bacterial Ana]ysks Sewage Dispos,.tl Syst_c_urt; On-si'Lc Syst. em (x) Public UtiliUy ( ) t-ermlk ,, Znst. a]!cd . /ins ~all. 1 cr Septic Tank Size Hanufachurer Absorphion Area coils ~ ............ ~-'' ' .,~d t.~ Nd. kO, l_a]. Distances: Well Lc) Sepkic 'Pank [:o Sewer L, ine No,.~rcsh Lot; linc t:o Neares'[: Lot Line to> Abs©rphion AreP3, Area Page I)epart:meF~c. of Health end NF, vi~-onmenha! RequesL [or Approval o:[' lndivhduai Sewer and Wake~- l,'ac:i_]i~ ins Lega.1 [)escriphJ.Ol]: Lot 12 Block 2 Nettleton Acres Subdivision CoRunen%s: Di_sapproved: DaEe: DepartmenE Wo.rkshoet: IVIUNIClPAI ITY O[: ANCHORAGE DEPARTMEN'i' OF HEALTIt AF,~D ENVIRONMEN'rAL PROTECTIO~ 825 L Sl:reet~ Anchorage, Alaska 99501 279'-2511, ext. 224~ 225 REQUEST FOR APPROVAL OF I~DIVI[)UA[, SEWEI~ m'~d WATER FA(}tl.I]iES Type of Inspectio.: 1. V/~ ................. FHA ............ 2. Property Owner' STEPHEN S¥¥ERSON Mailing Address: ..................... ~ ...........................Day Phone: ............ 3~=_85A9 3, Name of Buyer:..~C~Z~..~_.~L~ 333-1~18 ~OM~ Mailing Address: .....~5_..GA~4Bg~ ............................ Day Iht ne,...~A=9.~A.6_.AO~ 4, Name of Lending Institution: ................. ~.~L~8__~A~.,..A._~ADB_% , s .......... ~ Pmn- 279 7511 Mailinq Addre..s ................ ~.u_u_~ ~z u.u ......................................... 5. Name of Realtor or Agent: ....... _~¢~ Mailing Address: .............................................................. Phone: Location: ....~,~.._~ A ~ &..~_ ......... AE6 ......... ~ A 2~CTZC Z~S~CTZO~ In,~t ected: 7. Type of Facility to be , ), ~JO [klfms 8. Water Supply Type of Supply: Public Utd~ty_ ........................ Ind~vldua If Individual, nu~nber of dwellings presently served If Individual, depth of well 9, Sewage Disposal System WELL & SEPTIC INSPECTION 'l'ype of System: Public Utility .................... I-div d a tf i.dividual, date of installation 72-003(3/76)