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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE: DISPOSAL SYSTEM AND/OR WERE INSPECTION REPORT
NAMEPHONE
,
6 C-'�q )(�
.6 ❑UPGRADE
MAI LING ADDRESS ,
o
LEGAL.. DESCRIPT ON
COOT CD%� —
LOCATION ('
Well 1�-� y) �� r Absorpti�©rea f Dwelling
NO. QF BEDROOMS
MIT
PER�-������
DISTANCE TO: t�
-" r'`�
U
F- z
W �
Manufacturer
a -j
Material r
s s
No. of c partments
U)
Liq. rapac„L)L1{tx ) gallons
i
IF HOMEMADE:
Inside length
Width
Liquid depth
_
Well
Dwelling
PERMIT NO.
y
DISTANCE TO:
O Z Q
Manufacturer '�
Material
Liquid capacity in gallons
S h-
�
®
-j _C
.�
DISTANCE TO:
Well
Fo ndaf on
Nearest toLline
(
PERMIT N �
J u T
Z W
No. of lines
Length. f e h ire
N
Total, eq h pf lines
(
-
TrencL "P
Inches
Distance e 1 lines
'
F_
Top of tile to finish grade
Material eneath rile 21
Total of c e(al3arTFption area
Q
�"
.�^v. _ ly inches
®
Length
Width
_
Depth
PERMIT NO.
W
C7
Q I-
Type of crib
Crib diameter
--
Crib depth
Total effective absorption area
W
w
W
rn
Well
Building foundation
Nearest lot line
DISTANCE TO:
�®
Class o
Depth
Driller
Distance to lot line
_
PERMIT NO.
J
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE M%T�ERIA S
SOIL TEST RATIN � 4
p
8
—
—
INS�� ER
&s
REMARKS
{E?��t�2tIuCUcz,LC
LEGAL
APPROVED DATE �{
���
1-1 f T � A 124 A. , 1 ,5 47, fin an! �1 Y A. a Q� W���
' �EP�RTMENT OF HEHLTIN HND ENVlROMMENTM "QOTE71-I0u
823 'L' STREET, HNCHORRSERK99531
264~�720
����� .' :���
~~~ :
PERMIT NO82009I )
HPFLICHNT STEYEH L SKHGGS
LOCHTION MHHCUS
LEGRL L9 SCHR0EDER
P� BOX D C�UGI|�K
LUlSIZE 28089 �QUHRE FEET
TYPE OF SOIL ABSOsPTI3H SYSlso! 14: TRENCH
MAXIMUM NUMBLR OF - ] SOIL RHTlNG (SO FT/BR)� l23
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS
.;I z (Y
������:::J" EL
THE LENGTH DIMENS[O� IS THE LEMGTH (lN FEET) OF THE T�E�CH OR DRHINFTELD
THE DEPTH OF H TRENCH 0R PIT IS THE DIATHNCE GETNEEN THE SURFHCE OF THE
GROUMD pND THE 8OTTOM OF THE EXCHYHTIOH (IN FEET)
7HERE IS NO SET NIDTH FOR TRENC1ES
THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL 8ETWEEN THE Oil TFHLL P[PE
RND THE BOTTOM CF THE EXCHYHlIOM (IH FEET)
TO bv� 671 U I . V TO NK 11 Y& 1: 117EJ Not HIT KEF Us Tom L1 -Q P41 15
PERMIT HPPLIC�NT HRS THE RESPONSI8ILITY TO INFORM THIS DEPRRTMEMT DURING PAR
INSTHLL9TIO11 IHSPECTIOIWS OF HMY WELLS RDJHCENT TO THIS PROPERTY 11100 THE
NUMBER OF RESIDENCES f 111 THE NELL WILL SERYE,
�`U�A^bf:���
BRCKFILLING OF HHY SYSTEM NITHOUY FjNRL INSPECTIOH WiD APPROYHL 84' W
OEPHRTHEMT HILL 8E SU8JECT T0 PROSECUTION
A �� IF fit 10 3: A - E���1 MR, 0 T 71 U Q 44 � IV ! ON KH IT: �& J . � it. Elm i� 12
�Y
MUNICIPALITY OF ANCHORAGE SOILS LOG
s +�` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: _l.� >/ e DATE PERFORMED:
LEGAL DESCRIPTION: Z1 Gtl s/9
DEPTH SLOPE SITE PLAN
(FEET). Cir'
1 ' /
2 0 <<
a -
c `r ✓ ,�
3
E /
V
6
� r
7 .s
C �
8.-
v a
9 i3
10 c 4
it— (?y^T /Z`J �IeWAS GROUND WATER //v J S
�t�+�'►���� ENCOUNTERED? L
// aer., OV 2t r /1% O
-vr12 t/ H �y,, P
p� ��+~�+++� ++�t�'$ YES, AT WHAT E
00 TH?
Ic
C Va e�♦+a e R
14 !
15 U r ®n, lltotwl A. Sl)afir
No. 1.157.,E
16e
day
IL
19
eading
�+
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
I �v
PERCOLATION RATE /� (minutes/inch)
_ TEST RUN BETWEEN FTAND __ FT
CO,VMENTS1/i/2(' 6
PERFORMED BY. j�
- , CERTIFIED BY2-1E , '� i� �`�� DATE: � /",IZ Ye -
72 -008 (6/79)
MIHIMUMTDISTHNCE BETWEEN H WELL HND HNY ON~SITE SEHRGE DISPO�HL SYSTEM IS
�mcN���'� �E �UH�HOPRIVRTE !�ELL OR 130 TO 200 FEET FROM H PUB
UP`i�C WE!L DEPENDING
�r F/'U6LIC WELL
MINIMUMEon HNCE FROM H PRIYHTE WELL TO H PRIYHTE SEWER LINE IS 23 FEET HHD
/u f?cuMll-INi[Y SEWER LINE IS 75 FEET
NELLHLOGSL8REOREQUIRED AID MUST BE R�TUVNED TO THE DEP�RTMENT WITHIN �8 PHYS
y, / c w� � c �f-i' [ION.
OTHERHREQUIREMENT'S MHY was PL\! SPECIFICHTlONS HND CONSTRUCTlON �IHGpHMS �RE
|U lNSURE PR0PER INSTHLLHTIOH
���lr�; 1; iiF. I-
{ CERTIFY THHT
HHMyFHM[Llast WITH THE REQUIREMENTS FOR ON-SITE SB�ERS HND NELLS HS cET
OF" u /FE MUNICIPHLITY OF HNCHORHGE ~
2� I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH [HE CODES
S�GHED_�....... ..�`-�.._~
HPPLICHNT MHRION BOWEN PIPPEL~~��-~�--
T5SUED BY�.... ~�... .... ..... .... �DHT1: J
YK�J
�'Lk»d
^ �`~�
MUNICIPALITY OF ANCHORAGE
Departmeni_ if Health and Environmental _,rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit #�� �1Lo� . WELL 410.76 'l W R PERMIT
Applicant: a l6r) b. Ptp�2 Mailing Address:
Location: _�� �a Y�� _ Phone Number:
Legal Description J ��'� Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms:
DEPTH
Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
LENGTH
GRAVEL DEPTH
WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve. '
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of! public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31., 1 9 3 2
I 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 install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residenc is remodeled to include more that 3 bed -rooms.
Signed:,oi�� c L._ -r Issued by:
Applicant
Date:(7
SWP/024(1/81)
4f 4�
4�
�y �
C Co. dba
SULLIVAN VWATER • Q ATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION (9`
DATE • Started Ended
i
PERMIT NUMBER
KIND OF FORMATION
From
Ft. to
Ft.
From
—Ft. to
Ft.
From
Ft. to--L
Ft.
From
Ft. to C"
Ft.
From
o
Ft. to—Ft.-
Ft._From
From
Ft. to
Ft._
From
Ft. to J.,
Ft,
From
Ft. to
Ft.
From
_Ft. to-Ft.-
oFt.FromFt.
From-Ft.
to-Ft.-
oFt.From
_Ft
From—Ft.
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:
From—Ft.
DEPTH OF WELL
STATIC LEVEL OF
WATER F"r.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
From
Ft. to
Ft.
From
Ft. to_
Ft.
From
Ft. to---
Ft.
From
Ft. to
_Ft
From
o—
Ft. to--Ft---
Ft.From
From
Ft. to_
Ft.
Prom
to
_Ft.
_Ft.
From
to_
Ft.
_Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
_
From.
o-
Ft: to--Ft.—.--
Ft._.From
From—Ft.
Ft. to---Ft.--
o—
Ft.—
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to -Ft_
DRILLER'S NAME
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
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, sub/division, section, township, range)
Z— 9 5C -1 -71 -0e -r16.1 .
Location (address or directions)
52 /D 4 4'%692CGfS
(b) Applicant Name —�,
Applicant Address
CJ t
S
Telephone: Home 6�V � `�— Business
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder f ; Buyer ❑ ;Other El (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
/ ,t ( q g
(f) 'fvf�lr�Ft�H 9 iSll.�Il�lo� EERI INN address:
2. TYPE OF RESIDENCE
Single-Family,X Multi -Family ❑ Other
Number of Bedrooms —
3, WATER SUPPLY
Telephone
Individual Well 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
Onsitgyf Public C] Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11184)
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH., DATr, 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.
11
Name of Firm'' S 8, S WGIUVERINn Telephone %
Address SR B 196X
Date EAGLE RIVER, AK 99577 JUL I I 1 36
J
DHEP APPROVAL
Approved for C -L' bedrooms by Date
CoApproved Disapprove
Terms of Conditional Approval _
CAUTION
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 (11,84)
MUNICIPALIT/ OF ANCF
DEPT. IORA�;;,
OF HEALTH R
MUNICIPALITY OF ANCHORAGE (MOA) NVIRpNMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 ,)I
264-4720 1,
Legal Description: s�/ie�i
A. WELL DATA
Sa (�7L
B, C, D.E.C. Approved
14
Well Classification
If A, (Y/N) —
Well Log Presentoy W___
Date Completed �� Yield
-
Total Depth 81' Cased
to g/ Depth of Grouting "
Static Water Level
` Pump Set At 4�50 77 -dA^
Casing Height Above Ground —
h
11741 _ Sanitary Seal on Casing Q/w
-
Electrical Wiring in Conduit 0M
Depression Around Wellhead Ka
-
Separation Distances from Well:
To Septic/Holding Tank on Lot
� ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot _ c7 �— ; On Adjoining Lots
"
To Nearest Public Sewer Line
To Nearest Public Sewer
14
Cleanout/Manhole
.— To Nearest Sewer Service Line on Loth
Water Sample Collected by s
S ; Date
Water Sample Test Results _
��1 7 �s �� Cr_ -R> Si
_
Comments
ya lis G
B. SEPTIC/HOLDING TANK DATA
Date Installed �� 2
Standpipes &w
Depression over Tanke-to
Size /d0'D No. of Compartments
Air -tight Capso*
Pumping/Maintenance Contract on File (Y/N)
Holding Tank .High -Water Alarm (Y/N)
Foundation Cleanout —.
// Date Last Pumped —
—;for -
Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply WeIIQp /'- To Building Foundation
To Property Line
To Disposal Field
Z� / 1—
r.
To Water AkainnService Line 5y �Y To Stream, Pond, Lake, or Major Drainage
Course"- -
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata za,54Me — Type of System Design
Date Installed lam/ ` Z Length of Field
Width of Field Depth of Field /3 r
Gravel Bed Thickness 6r
Square Feet of Absorption Area 3 Standpipes Presentr�ww —
Depression over Field 4YO Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well /Oy L To Property Line — �p
To Building Foundation To Existing or Abandoned System on
�
Lot � : On Adjoining Lots
To Cutbank (if present
ti�
Yo r J__
To WaterAdain Service Line
r .ti. -
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
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) —
Comments
A -1k
— Dimensions
Manhole/Access (Y/N) _
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
SignLad S S ENGINEERING Date
SR B 196X
CompanyMOA No. S —U c� ����'�®
EAGLF RJVEr'R, Ag, 99577 '�� GE
Receipt No. I L� C y �. �� ° ° No°• a°#0
Date of Payment
Amount: $ Cnio
jo
..�..1 .,�.............�... «!
f1% hart & shbkf ,' 4
Page 2 of 2ti<n`'0••...••°^'���
72-026 (11/84)
5
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
I. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name Teleyhone� Elome� Business
Applicants Address��
(c) Applicant is (check one) Lending Institution
Buyer E::l ; Other E::j (explain); M� ; Owner/builder ;
(d) Lending Inst:Ctution-�Telept�one
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Tye of. Residence
Single -Family
Number of Bedrooms
3. Water Supp
Multi -Family =
.:3
Other Sdescribe)
Individual Well EKI Community = Publicly
Notre: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Dis osal
Onsite 5�j Public =1 Community E----1 Holding, Tank =
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 21
5. Engineerin 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 regula-
tions in effect on the date of this inspection.
Name of Firm�7-e) .6,6 e S
Telephone a? 7 Oji. -
Address u
DateOr At
p' �}' �� m.. •.
(ENGINEER SEAL) 4^-'i ,k • ;�
r
I
6. DHEP Approval o� 2 2 2 �E:
1371
Approved for iN/.(3�bedrooms By
wpa to / mac Ay
Approved /A Disapproved _ Conditional
Terms of Conditional Approval
CAUTION
THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL, AND STATE
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
PROTECTION
REPRESENT -
REGISTERED
HOMES AND
REQUIRF.-
BEFORE A
FOR ERRORS
[Page 2 of 21
7-19--84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MONICI>A[I -iY OT / INCFICeAC::
GLFT. Cr- FI�ntTrl /�:
CI��VIr.Oivi�4tP�ll�L ; i�,Tf <;ilOi�!
NOV 2v9984
R CFS V(E:D
Legal Description: /_of Sc-hrue=de,
T-/ ra N Ae .z 441 s' -e c a --
Well Classification /'ysvct /fie If A, B, or C, D.E.C. Approved(Y/N) 4 -//y -
Well Log Present (Y/N) % Date Completed /1,faYield Lo Gni
Total Depth � Z/ Cased to 8 / "
Depth of Grouting /L
Static Water Level Z/5- " Pump Set At
Casing Height Above Ground —21e " _
Sanitary Seal on Casing (Y/N) y
Electrical Wiring in Conduit (YM) %
Depression Around F,bllhead (Y/N) eV
Separation Distances from Well:
!
--
To Septic/Holding Tank on Lot /6J0
On Adjoining Lo s
To Nearest Edge of Absorption Field on Lot /ate
; On Adjoining Lots ioe e�
To Nearest Public Sewer Line
To Nearest Public Sewer
Cleancut/Manhole e— To Nearest'Sewer
Service Line on Lot Qs-
SWater
WaterSample Collected By ;15 )„ee r Date
Water Sample Test Results
Came
4 7- .moi rr / />-7 , l
B. SEPTIC/HOLDING TANK DATA
Date Installed - /1 cY J Size /Ooo C51 No. of Ccmpartments ZZ
Standpipes (Y/N) Air -tight Caps (Y/N) Foundation, Cleanout (Y/N)�__
Depression over Tank (Y/N) // Date Last Pumped /U / Zr
Pumping/Maintenance Contract on File (Y/N) N//A ; for _
Holding Tank High -Water Alarm (Y/N) N1 Temporary Holding Tank Permit (Y/N) /V/4
Separation Distances from Septic/Holding Tank:
To Water -Supply well. M) -To Building Foundation ao
To Property Line /o '# - To Disposal Field 6'1 _
To Water Main/Service Line /v ''` - To Stream, Pond, Lake, or Major Drainage
WA C 1441.
(Page 1 of 21 yl
2 -i5 -e4
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata j 2 S 0 Type of System Design
Date Installed /y Length of Field _
Width of Field �3G Depth of Field
Gravel Bed Thickness _F
Square Feet of Absorption Area ___376- Standpipes Present (Y/N) y __
Depression over Field (Y/N) %v Date of Last Adequacy Test
Results of Last Adequacy Test Sczr4 lsfaC,hlr y
Separation Distance from Absorption Field:
To Water -Supply Well /OU / To Property Line /o _
To Building Foundation ` :?d" To Existing or Abandoned System on
LotN� �_ % On Adjoining Lots 3-1 -/-
To
To Water Main/Service Line /U -24 To Cutbank(if present) /done
To Stream/Pond/Lake/or Major Drainage Course lVari-e.
To Driveway, Parking Area, or Vehicle Storage Area
Comments 7nGr a (e 4Q� Cc�Sorf,e�( Soo r/F//.
D. LIFT STATION
/t -/"4
C/ /
/4
Date Installed Dimensions
Size in Gallons
"Pump On" Level at
Manhole/Access 1ye2j)_��__
"Pump Off:" Level at
High Water Alarm Level at Vent (Y/N)_�
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes(Y/N)
Comments
*� Check Permitted Bedroom Rating Against HAA Request **
I certify that I have.checked, verified,'or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed mt —Date t6 j fie",
C( mpany e b A � l MOA No. SST- - e- e 1 /
KBl/d5/s
(Page 2 of 21
0
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RS
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JUNE 25, IJ/1
4
y4 .
2-15-84
Tobben SPurkland P.F.
T-,
Lir `j e-ee
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t4l
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--y-
ACiO??iGE/}acSTERi; DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
iobbern Spurkiand
203 .lest 15th Avenue
"C" Suite 203
Anchorage, Alaska 99501
274-2533
November 19, 1994
na�.;�iaFa..i_rr.r O. f.��a�oPAGE
OF
FNVIF.ONF/,EP�T1.L rZOTECTION
REC.Ili I -D
SU?JECT: Waiver Horizontal Separation between Nell and Septic
Tank, Lot 9, Schroeder S/D
(8521-14A-068)
Dear Mr. Spurkland:
The Department has reviewed the.subject waiver request and hereby waives
the horizontal separation between the.-well--arid,septic tank to 84 feet
between nei Otbori ng properties for 3 bedroom `ski ngl e family resilience
only.
Br a
r-Uld
3
Sincerely,
'Bruce E. Erickson
District Enain.aer
C6 Dto
CONSULTING INEER
October 22, 1984
Mr. Bruce Erickson
State of Alaska
Department of Environmental Conservation
437 "E" Street, Suite 303
Anchorage, AK 99501
Subject: Lot 9, Schroeder
Dear Mr. Erickson,
?03 lY. 15111 AVE "(," ;UI1 L. 209
ANCHOFIAGL, .1LASf<A 99501
TL I_EPHONE: (9071 279-3916
This letter is a followup to the letter dated 10/15/84 in order to clarify
any possible discrepancies. As a result of discussions with the Municipal
Health Department, it has been stated that in order to obtain a Municipal
Health Certificate for Lot 9, it is required that we obtain a State D.E.C.
issued waiver or approval of an 84'
This is due septic tank to well separation distance.
to the fact that the septic tank on Lot 9 was installed with
the well on Lot 70 existing previously, Well (Lot 10) to leach field (Lot
9) distance is 100' assuming a 6' distance between tank and leach as shown
on inspection report 3/24/82 is correct. We are therefore requesting specific
waivers:
1. Septic tank on Lot 9 be allowed to exist at 84' from the existing well
on Lot 10.
2• Well on Lot 9 be granted waiver to 90'
septic tank. separation distance to Lot 10
As shown on the attached paperwork, the well and septic systems on Lot 10
have never been Municipal approved, a well log for Lot 10 is not obtainable.
Available records (attached) show application for a 4 bedroom usage on Lot
10. As the issuance of separation distance waivers is necessary to obtain
a Health Certification, and as an 80' separation distance was in effect
at that time with Municipal endorsement, we request waivers be issued, allow-
ing Lot 9 to possess an approved 3 bedroom well and septic system as was
intended by previous Municipal inspections.
Sincerely,
i
i
Tobbeh Spurkland, P.E.
cc: Virginia Kohfield
Re/Max Eagle River
TS/bh
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JUNE :'.S• 1971-.'�
October 15, 1984
Tobben Spurkland,
203 w. 15th #203
Anchorage, Alaska
279-3916
Mr. Bruce Erickson
437 E Street 2nd Floor
Anchorage, Ak. 99507
Reference: Lt 9 Slc6meder Subdivision
Dear Mr. Erickson,
P.E.
99501
On behalf of our client, Virginia Kohfield Re/Max
Realtors, we are requesting that waivers be granted in
order that a Municipal Health Certificate may be
obtained. The necessary waivers involve well. to septic
tank separation distances. As shown on the attached
Plot plan, the well that services Lot 9 is 90' away
from the septic tank located on Lot 10. It is also
noted that the well on Lot 10 is 84' from the septic
tank on Lot 9. Development on Lot 10 preceded the
development on Lot 9. The Municipal on site sewer
Permit issued in 1982 indicated the approval of 80,
tank to well separation distances as evidenced by
attached paperwork. The well log for the subject well
on Lot 9 is attached, the well log for Lot 10 is not on
record. Please contact our office if waiver is to be
granted.
Sincerely,
Tod en Spurkland, P.E.
cc: Virginia Kohfield
Re/Max of Eagle River
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APPLJC VT FILLS OUT UPPER HAI ONLY
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Realty Co. R Agent Zip Code
Address > o
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Legal Description ._
Street Location
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Type of Residence
,)KJ Single Family
❑ Multiple Family No. of Bedrooms
❑ Other
Water Supply
A� Individual
Phone
Phone
11
❑ Community ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Public Utility For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal
`p Individual
❑ Public Utility Year Individual Installed: / `•� .�
❑ Holding Tank When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.