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Home My WebLink AboutARVESON LT 9h; V 'LSO WELL DRILL[ G ` ANCHORAGE. ALASKA 90509 j PHONE i3R-034,04- "./ V 343":./V -/i 7'i W_r9 /n/ DRILLING LOG Well Owner.... 17e(• . /L.'Lc}L1 Use of Welt y ' Iw+catlan (address of: TOWnship, lunge, Section. if known; or distance main road `'.I L -CL Size of casing feet Cased to '1CL_fect Static water (above) ��;•i land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation.._.__-- _—_ Well pumping test at_'IL.gallons per (hour) tminute) torte —hours with /C It. of drawdown from static level. \`'--' Date of completion_ , vC" t v, 1 WELL LOG Depth ut feet from ground surface Give details of formations penetrated, size of material, color and hardness (Scat f ' _j 1 2'?-To-�.5EN. _ i�Cc�f1 �Lt�_,�'�k-cc.)— CIP rice. (Jr[ni' _-Jaw- /4LY<IPh C� Gt n _ _0K �P ( e . 0.P/t, LP1,0 (0i it rano h,11? --/iL�CLPf�.Gt'_2ccL.Ctf au.TcA' !r)L{i,r�ri� ..��S:.�ft��►.ki.--=' c:l- -E.G ��,��Cct,d lu�l.vc(' n p r + vSpo.( ( � Ct cre- 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 (9O7) 343-79O4 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-14 GENERAL INFORMATION Complete legal description Lot 9, Arveson Subdivision 'Location (site address or directions) 11121 Shady Lane Expiration Date: '7 - / ~" ° o ~ Current Property owner(s) Mark Ebel Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 2. NUMBER OF BEDROOMS: 11121 Shady Lane Anchora.qe, AK 99516 Day phone 349-9016 Questa Locke Prudential Vista Real Estate Unless otherwise requested, HAA will be held by DSD for pickup. Three (3) Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System [] Well [] Day phone 350-2322 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old. (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 er 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 o 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 flies and from my investigation and inspection, the on-site water supply and/or wastewatar 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 Andemon Engineering Address P.O. Box 240773 Anchoraqe, AK 99524 Engineer's Printed Name Michael E. Anderson~ P.E. DSD SIGNATURE [,~ Approved for ..~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 4/9/2002 .. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's RePort Other Original Certificate Date: (Rev. 12/C0) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewator Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 (~07) HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lotg, An~sonSubdivtslon A. WELL DATA Total depth 201 ft. ifA, B, or C provide PWSID # Sa~tary ~ (Y/N) ~_ FROM WPl I LOG Date of test t0/2~g78 Static water level 131 ft. Well production 20 g.p.m. Nitmfe .682 mg./I. WATER SAMPLE RESULTS: Catifonn 0 cdonies/100 mi. Date of sample: 4rjr2002 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sepflc~tHI Tank size t,~00 gal. Foundation cfeanou((Y/N) Y_ Date of pumping 4/12t2002, C. ABSORPTION FIELD DATA Number of Compartments _2 Parcel ID: 015-27~-t4 Well Log (Y/N) Y Wires prope~ protected (Y/N) Y Casing height (above gmend) 24 AT INSPECTION 140 ft. 5.? g.p.m. in. Oeano (y/N) ¥ Delxession over tank (y/N) N High waior alm'm (y/N) N Pumper AnchoraoeCesspool Pumping Sellmtiog (g.p.d./ff~or~/bdrm)110GPD/SF Sysfem type DeepTrench ft. Width ZB7 ft. Gravel below pipe 4 Date of adequacy test 4J7/2002 Results (Pass/Fail) Pass Fluid del~th in absorption field before test 30 in. Water addedS02 gal. Elapsed Time: 70 min. FinaJ fluid depth 34~ in. Absorption rata >= 450 Any n~iton Imatment (past 12 mo.) (Y/N & type) ~ If yes, give date For :~ bedronms Now depth4~t in. g.p.d. LIFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank~ilt station on lot >100' Absorption field on lot >100' Public sev~a' main NrA Sewer/septic service line. >25' Manhole/Access (Y/N) High water elarm level at Meets almm & circuit requirements? On adjacent lots >100' On adjacent lots >100. Public sewer manhole/cleenout #/A Holding lank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main NIA Water sewice line >10' Wells on adjacent lots >100. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine. >10' Water Service line. >10' Curtain drain N(me Noted COMMENTS G. ENGINEER'S CERTIFICATION Building foundation >10' Surface water >100' Wells on adjacent lots >100' I certify that I have determined through field ir~s and review of Municipal records that the above systems are in conformance with MOA HAA gu/defines in effect on t/~is date. , Engineer's Printed Name Michael E. Anderson~ P.£ Date 4/9/02 HAA Fne $ Date of Payment. Receipt Number (Rev. 12./00) Absorption field >5' Surface water >100' Water main >10' Driveway, paddng/vehlde stmage. >25' Waiver Fee $ Date of Payment ANDERSON ENGINEERING; :' "~ P'O' BOX 240773 !' :'~,~'~ ' ~ . ANCHORAGE, AK 99524~ . ':,; ~i 522-7773 :.'..'::~. 522-6779 (FAX). '~: ,:' April 10, 2002 Prudential Vista Real Estate 4241 B Street Anchorage, AK 99503 Attention: Questa Locke Su~e~: Lot 9, Arveson Subdivision Well and Septic System Inspection, Testing and Certification Dear Questa: At your request we inspected the well and septic system on the subject lot to determine the requirements for certification by the City. Prior to the inspection we inspected the Municipal records and found the septic system was originally constructed in 1978 and was composed of a 1,000 gallon septic tank and a 43' long by 4' effective depth absorption trench. The well was also constructed the same year and is 201' in depth with 6" steel casing the entire depth. The septic system was last tested and certified in 1999. At that time the absorption trench had 23.5" of standing water. Our measurements indicated 30" of standing water, which may mean that the absorption trench has deteriorated nearly 13.5% since 1999. We injected 500 gallons of water into the trench and the water elevation rose to 41". The water was absorbed into the trench at a rapid rate with over 40% disbursement in 70 minutes. We conclude from this test the trench is capable of absorbing more than the required 450 gallons of water per day and meets Municipal requirements for certification. It must be noted the septic system even though it is functioning adequately at this time is more than 23 years old and well past the average life of a typical absorption system. We noted the adjacent property owner to the east had excavated vertically at the property line to a depth approximately 5' below existing ground. This excavation occurred many years ago. This vertical excavation is approximately 20' from the absorption trench, but the bottom of the excavation is apparently above the flow line of the absorption trench. No sign of effluent was noted in the sidewall of the excavation. The static water level in the well was originally measured at 140' below the ground surface. This compares with 131' shown on the well log and 149' registered in 1999. Water was allowed to run freely from the well through a hose bib located in the garage and through a 5/8" hose with a volumeter. Flow was measured at an average rate of 5.7 gallons per minute with the static water level in the well stable. The well is therefore capable of producing in excess of the required 450 gallons per day. A sample from the water system was found to be free of coliform and other bacteria with only a trace of nitrate content. The well and water are therefore eligible for Municipal certification. Sincerely, Michael E. Anderson, P.E. Attachments 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 ^PPROVA, .OR A S~NGLE .^M~LY DWELUNG GENERAL INFORMATION Complete legal description son Location (site address or directions) Property owner _/-- Mailing address Lending agency Mailing address Agent· Address" Day phOne 3~/~{-;;;;L~'~['~ :'" Day phOne Day phone. 2"7 ~'~ ~"7'~j Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -~ 3. 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: 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 supplYan¢ Engineer's signathre · Approved for ~?--~ bedrooms. Disapproved. Conditional approval for :_ ,..., Date bedrooms, with the following stipulations: Additional Comments Date .= Department o~'Health~ and Human Service~-i~)~l~S) iSSUes Health AUthority ~ Approval Certifica. t.?s~based only upon the representations, given in paragraph 5: above by an' independent ,'professiOnal engin~r registered in the State of Alaska. The DHHS dOes this as a courtesY t° purchasers of homes · . an(i their,lendi,n,~ insti~utionsin order to satisfy certain f~eral and state requirementS: EmPloYees of DHHSdo not · COnduCt,;:i~tionS~°r 'analYZe .data.~bef°re a,lcertificate :is iSSUed. The Municipality of AnchOrage is not · res~nsibie for"' e~r°rs~or?°r~'jssi°ns in the pr~f~ional'engineer's w°~:k. 'r * '' ' ' ' ~ '~ .... , ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~3~P~7,4~to~ ^NCHO~e ~:N¥1RONMENTAL SER¥1CES DIVISION RECEIV[/ .m~ 11 199~ Health Authority Approval Checklist Legal Description: ~.,~-['" C~ ~¥ ~/d.,GOl/I Parcel I.D.: O ts -~7~ - Iq A. WELL DATA Well 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 Cased to ~ / FROM WELL LOG Date of test lc) I~-G/7~ Static water level / ~/ Well production ~ g.p.m. , Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: Oi/Oql Nitrate /, / D Other bacteria N- Collected by: -~.._~ B. SEPTIC/HOLDING TANK DATA Dateinstalled ~/lol 7~ Foundation cleanout (Y/N) Date of Pumping I/~/~ ~ C. ABSORPTION FIELD DATA Date installed ~/t0 / 7~-~ Length .J~J~,~ / Width Tank size [o"OO Number of Compartments ~ Cleanouts (Y/N)._./~/_.__. y Depression (Y/N) N High water alarm (Y/N) ~,~ Soil rating Effective absorption area Date of adequacy test o (g.p.d./fta or fWbdrm) ,//~ System type ~1 Total depth · Depression over field (Y/N) ~'~ For ~ bedrooms Gravel thickness below pipe Monitoring Tube present (Y/N) Y Results (Pass/Fail) ~ Fluid depth in absorption field before test (in.); ~ Immediately after~,20 gal. water added (in.): Fluid depth ~"~ ~/'L (ins) Minutes later: ~/4v',,,, ~ Absorption rate = ~ ~"/.,3 g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons High water alarm level at* "Pump on" level at* "Pump off" level at* Cycles tested *Datum E. SEPARATION DISTANCES R SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots ~ 10-C) On adjacent lots ~ to'c) Public sewer manhole/cleanout Lift station 1'4/,Z~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ Property line .~O Absorption field Water main/service line ~..R Surface water/drainage /q ~o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lC) Surface water r'-{ ID curtain drain Building foundation .~O~' Water main/service line Driveway, parking/vehicle storage area --~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 Location (site address or directions) Property owner Maiiing a~ddress Lending agency Mailing address Agent "~o ~, Address Day phone Day phone Day phone Unless otherwise 'requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ · ' ........ -; £. .....'; ~...L. ;~:-2,.~.. ...... 3. TYPE OF WATER SUPPLY: ............... :,,,L,~ -., ~ *',~ ;~,J;~,:L~,..i. ~.....: ....... J .... Individual well Commfinity well Public'Water .~.. ~,, . ':.(.,'. ;t-J,,' [1 f,,*~ ., '~ NOTE: If communi~ well system, provide wriffen confirmation from ~tate A~EC a~est lng to the legali~ and status of system. -I , ~ ~' ,' . TYPE OF WASTEWATER DISPOSAL: ',.. ~ ' ;,,'~',{t~'~ .? .: Individual o n-site Holding tank . ' Communi~ on-site Public sewer NOTE: If communi~ wastewater system, provide wfi~en confirmation from State ADEC a~esting to the legality and status of system. .~ .:.- ..... 72-025(Rev. 1/91) Front MOA#21 ' 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm t c. ~b.d_ ~-~ , - Address ,~2,.0 ~ Engineer's signature bedrooms. DHHS SIGNATURE ~X_ Approved for 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. 72-472.5 (Rev, 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. /~ I'~)'~ .,~-'77') -- I ~. A. Well Data Well type ~ Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number ~/'/'~'"'" Date completed JO 12-6 ~ 7,R" Driller Cased to .,-,~O I Casing height ,.~ v Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ~,~-O g.p.m. ~", i)"' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot J ~ ~ ~ Absorption field on lot J J & Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots ~J[/,~ Public sewer manhole/c lean out ~ ,.~"D Petroleum tank WATER SAMPLE RESULTS: Coliform ~~/~../ Date of sample: _ ~' ~"" B. SEPTIC/HOLDING TANK DATA Date installed o 7~" Cleanouts (Y/N) High water alarm (Y/N) Date of pumping __~ (~/")--/'~'~-- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I "~ "~ ''IL To property line ~ Surface water/drainage Nitrate (~'. ~-; / Other bacteria Collected by: ~ ~ Tank size l ~ ' Compartments Foundation cleanout (Y/N) y Depression (Y/N) //.-N Alarm tested (Y/N) On adjacent lots i ~.~ Foundation 'c~ y ~,.~o~ption field 15 Water main/service line /~ ~'''C'~) 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width Soil rating (GPD/FF) ~--/~ Gravel thickness Cleanout present (Y/N) Results (pass/fail) System type '"T ~ ~_~_. )k~l~ ~ Total depth f'~ '--I I Depression over field (Y/N) J"'-/ -~ Bedrooms for Se" ~' ~ '7,Z.~ After test ~-'~ ~"* ,_E_ J~c~¢-~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot il ~ To building foundation On adjacent lots "~0 Surface water Curtain drain \'~ On adjacent lots l ~O ¢ Property line To existing or abandoned system on lot Cutbank ~ o ~,.4.___- Water main/service line Driveway, parking/vehicle storage area ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,e0 the date of this in§pection. HAA Fee $ Date of Payment ~ ~(-~"- ~' ~- Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number APPLIr' ,NT FILLS OUT UPPER H/) 'ONLY Yro~.,y Owner ,4/h~l<' /,/-l~j-,,j~=~ Phone v ~ ~ .,- ~ ,Phone Lending Institution Realty Co, & A~nt Phone ~ ~::.' /~-~ t~ Address Zip Code Type of Resi~nce ~Single Family ~ Multiple Family No. of Bedrooms ~ Olher Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~ ' DEPT. Of: c. o ~ ~ ~ co.~,~o.~ Soils Rating Date ~wer I~[alled Well To ~sorption Area Well Log Received 2~?Y Well ,o Tank Septic T~k Size 72.023 (3182) ALASKA ~,IUIROFllTII~FITAL COFITROL S~,~dlCE~S, IrIC. ~nqineerinq G ~nuironmcnlot Sludies MARK HAYNES 11121 SHADY LANE ANCHORAGE AK 99510 APRIL 5 1983 STATEMENT SBDN ARVERON SELLER- MARK HAYNES BLOCK 0 SEPTIC TANK PUMPING ADEQUACY TEST WATER CHARGE LOT 9 BUYER- 65.00 235.00 0.00 $300.00 IF DESIRED PAYMENT MAY BE DEFFERED TO CLOSING AND MAY BE PAID FROM THE ESCROW ACCOUNT. PLEASE LET US KNOW. THANK YOU 1200 LUcsl 33rd Aucnue, Suite ~ ~,/:~nchora§¢, Alaskc~ 99,503 ~, [907) 276-1361 ALASKA IUIRO[lmeFITAL COFITgOL IrlC. [~nqincerino G ~noiPonmcntol Studies APRIL 5 1983 MARK HAYNES 11121 SHADY LANE ANCHORAGE AK 99510 SELLER - MARK HAYNES BUYER- SUBDIVISION-ARVERON BLOCK-0 LOT-9 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 344 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 2 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 4/5/83 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 2 BEDROOM HOUSE. 1000 IS ADEQUATE FOR 1200 LUcst 33r'd Aucn~e, Suite B * Anchoraq¢, Al~sk~ 99503 · {907) 276-1361 ..... (' .1983 lqark A. flays,es P. O. !sox 10-i32.6 f~nchorage, Ak 995t. 1 Subject~ Lot 9, ,.w:r~-~c.l /~pproval fo'r the individual sewer and :,~ater facilities cannot be 9ranted until cbc followin9 items have i.)een ~ ~B~--Tho water analysis t~e[)ort needs to be subn~itte~ to this ~%,~ of.:[[ice Jfrc)~a the Chel'a L, ab, 5633 l] Street, ior our review. ,~eDLlc tank pun~ged with a receipt sub-ii~itted to this A four (4) inch ciea~'~out needs to be i~staiie~ to the leaci~ in~j area. A = - ~.our (4) inch cleanout needs to be in,;tailed to the '~-'."~ - /~n adequacy test nec, ds to be I)er~or:~ed on thc existin9 leaching3 area. This test %-~itt determine if the syste~n is adequate accor<]ing to National Standards. A tisti,ug private firr~;~s perf<)rmin~.~ tl~e test is ~:nclos~:d. This needs to be su~)mlttect to this office :for our review. Please notify this Department ~or a rcinst)ection '~-;hen t. ht~. noted discrcpancie.~'3 have been corrected. If there are any further ~' ~" *) '~-~" ~' '' · du~.~tion~, L-£-a,~. call this ofl~ice ~.~t 204-4730 Si~cerely, Jl,<210/ej/Ei J i~ r~oberts Associate los ~ re , DA'I;E RECEIVED _ E ..... INSPECTION APPOINTMENTS~'t ~J~'~--'; ~' TIME TIME ,~ [ TIME DATE DATE ....M DATE MUNICIPALITY OF ANCHORAGE ~UNICIPALI~ OF ANCHORAGE DEPT OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~j .... ' 825 L Street - Anchorage, Alaska 99501 ]K~ENTAL P~OTECTION ENVIRONMENTAL SANITATION DIVISION JUN 2 5 1981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be preceded. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS ~ ~ ~ ~' -~ ~-~ PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE 3. LENDING INSTITUTION ~ PHONE I MAILING ADDRESS 4.' R~ALTOR/A~NT PHONE' 5. L'EGAL DESCRIPTION 6. TYPE OF RESIDENCE S INGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Other Two [] Five Three [] Six ' 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 I NDIVIDUAL/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 [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tan~k or []Holding Tank Size: l ~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] TWO [] THREE [] FIVE [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER ~ MATERIAL Septic/Holding Tank ~Absorption Area I Sewer Line [] OTHER INearest Lot Line 5. COMMENTS DATE I~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE _ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~[INICIPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPT. Oi: t{[~AL'rH & ENVIRONMENTAL i-'; ENVIRONMENTAL ENGINEERING D WS ON REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~I,I[t~ I~ ~/v~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. 1. PROPERTY OWNER ~ ~ . / PHONE MAILING ADDRESS . ~ ' ~ROPERTY RESIDENT (If Oif'e:ent fro~ above) / ~ ¢//~' 2. BUYER PHONE' cc ~AILING ADDR ~SS - ,_ 4. REALTOR/AGENT PHONE C MAILING ADDRESS '~* jR 5. LEGAL DESCRIPTION ,-- E E'P'LOC~,TI ON -- - ~ - NUMBE~OF ~ > ~'1 8. TYP~OF RESIDENCE BEDROOMS ~ One ~ Four ~ Other 8INGLE FAMILY ~ Two ~ Five MULTIPLE FAMILY ~ Three ~ Six 7. WAT R~UPPLY LZJ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM N~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) .,,~/:::'~' ::,..m.~ .,~ , **If individual/on-site, give installation date./~ 1 ~ ~ ? If sgstem is over two {2) gears old an adequacg}test is required bg this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME ~ DATE DATE INSPECTOR I NSP ECTOR I NSP ECTOR -~'h--~-~T I O N S: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2, WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: ,,/O_~/:~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MATERIAL Absorption Area to nearest Lot Line Septic/Holding Tank Absorption Area .iSewer Line INearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [_~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED LEGAL DESCRIPTION (Title) 72-010 (Rev. 3/78)