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HomeMy WebLinkAboutSCIMITAR #2 BLK 2 LT 27MUNICIPALITY 01= ANCHORAGE / ¢ \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ` ENVIRONMENTAL ENGINCERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 =� ON-SITE SEWAGE DISPOSAL SYSTEM ANWOR WELL INSPECTION REPORT NAME �...___:-���._T-� PHONE EW �3, Gly P �PGRADE MAILING ADDRESS LEGAL DESCRIPTION ? LOCATION / P NO. OF BEDROOMS Wallf Absorption are Dwelling� U DISTANCE TO: I U l_— �� /✓O� Y PERMI O /— /J� a Q Manufacturer` Material^ uj No. of compartments Liq, capacity n gallons Inside length Width 10�� IF HOMEMADE: MADE: Liquid depth v� A C7 Z DISTANCE TO: --..._- Well -- I Dwelling L---- PERMIT NO. — pz Q 2 - - Manufacturer --__-- - Material --- — Liquid capacity in gallons O wx w Well/ I DISTANCE TO: /U --- - No. of lines Length of each I tie Foundation � ___Nearest C��r Total length of line lot line �� - - Trench width PERMIT NO. - Distance between lines riches qq b Top of We to finish grade I �� �. Total effective, absorption a ea Material beneath the �__._._�T_.,L.l inches ua Length Width Depth PERMIT NO. c(h a - -- Crib depth Total effective absorption area Type of crib Crib diameter uj N DISTANCE TO: Well Building foundation Nearest lot line Class DISTANCE TO: Depth f Building foundation Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER` - - - - PIPE MATERIALS SOIL TEST RATING -- -- INSTALLER 1P REMARKS P _ t K C f - I— � —7 — rr -- — - I APPROVE DATE LEGAL —®� 0�- , Q����� ~— DEPRRTMENT HEHLTH HND ENVIRONMENTHL �OTECTION �1�«/' ' " 825 'L' STREET/ HNCHORRGE/ HK99501 » /\ 264 4720 q �\ Big ME p E Vl lEn, T PERMIT HPPLICHNT BILL THYLOR 147] W. 25111/ #]0H 277�9]87 LOCHTION T LEGHL L27 82 SCIMITHR S/D LOT SIZE 47000 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM ISDRHINFIELD MHXIMUM SOIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL HBSORPTIOH SYSTEM IS� 11 ..- 0.�� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVAl, ION (IN FEEI- ��V-4 R--.-, IT— IT Z!! 11- -9 1 --q1:�11- 9-11 1:� THE GRHVEL DEPTH IS THE MIMIMUM DEPTH OF GRRVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) FT: K pit U I FY K 110 IIIE7 T:-*:,, - E- I Bi- �rf:7p P-J�l 3- B�E �.... �P.,� PERMIT HPPLICONT HHS THE RESPONSIBILITY TO INFORM THIS DEPHFO' MENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS AD -34 -ICT -I'll TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAI' THE WELL WILL SERVE. �������I V-4 "E -� U;;;?, o:7,!! IF Ll BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVRL BY THIS DEPHRTMENT WILL BE SUBJECT TO PRUSECUTION MINIMUM DISTANCE BETWEEN H WELL HND HNY ON�SITE SE�HGE DISPOSHL SYST�M IS 180 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT NITHIN ]0 DHYS OF THE WELL COMPLETION OTHER IR REQUEMENTS MHY HPPLY� SPECIFICHTIONS RND CONSTRUCTION DIHGRHMS HRE HV8ILHBLE TO INSURE PROPER INSTHLLHTION FG! T-0 l , T I Fy�, U�.` �E�'::: irl Ei:,"��� I CERTIFY THAI 1� I HM FAM ILIHR WITH THE REQUIREMENTS FOR ON—SITE SENERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THAT THE OOYSITE SEWER SYSTEM MW REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED... .. .... .... HPPLICH-41 8IL�/THYLOR ISSUED BY ���._DHTE ~ V40 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 27 DEPTH (FEET) 3 J 7 10 Date Gross Time Net Time Depth to Water Net Drop 15 - A� WAS GROUND WATER 11 16 sLt ENCOUNTERED? 12 - R 17 .. ............. -� 18- IF YES, AT WHAT iRtbberj A. S I r No. 145 0 191 DEPTH? 13 4 ec, A? till, 14 - Date Gross Time Net Time Depth to Water Net Drop 15 - A� 16 sLt - R 17 .. ............. -� 18- iRtbberj A. S I r No. 145 0 191 4 ec, A? till, Z U 20 COMMENTS SLOPE i 4- 4— I F -FT i SITE A, 0 s I L 0 P E 27 Reading Date Gross Time Net Time Depth to Water Net Drop �Aj sLt I L A, 0 s I L 0 P E 27 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: S I-- 'S rimineezinq CERTIFIED 72-008 (6/79) (minutes/inch) FT AND — FT DATE 4 Y aod Y' coo 00 R* _R* C 0 �e Y J � Q � M a00 3 D s V F n A F [ m 1 F F m a Y 'Q� Q p ® Y � mow w w a w w Q _a w A J no i Q = U 3 O W > O O O Q a [- Lu u m C9 cw, w p W E- Q F F F A w O O 0 o ¢ 3 F A O O a Y J � Q � M a00 3 D s V A F F A F [ F F F F F e4 [- w w w w w w w w A w F O O O 3 O o O O O Q O [- v A C9 cw, w p 3 E- Q F F A F F A F [ F F F F F F [- w w • w w w w w A w F O O O O O o O O O Q O [- F F F F 3 E- Em F F F A w O O O o ¢ 3 A A F F F F [ F F F F F F [- w w w w w w w w w w O O O O O O o O O O Q O [- F F F F H E- Em F F F F O O O M, y O�' �� O O t O' O O O O w F4 O .4 O O O O O O O O o O O O x x x x x 9 C4 9 9 x a w w w w w w w w w w w n F F F F [ F F F F F F [- w w w w w w w w w w O O O O O O o O O O Q O [- F F F F H E- Em F F F F F F F [ [ FF+ O .4 a p rOL cOL rOL a a z MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920037 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:SMEDLEY FRANK R & D LORENE OWNER ADDRESS:PO BOX 670122 CHUGIAK, AK 99567 PARCEL ID:05113245 LEGAL DESCRIPTION: SCIMITAR #2 BLK 2 LT 27 LOT SIZE: 47520 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 3/24/92 EXPIRATION DATE: 3/24/93 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: NOTICE: AQUIFERS IN UNCONSOLIDATED STRATAS MAY NOT BE USED AS A POTABLE WATER SOURCE. WELL CASING MUST BE DRIVEN INTO BEDROCK TO PREVENT MIGRATION OF CONTAMINATED WATER. IT MAY BE NECESSARY TO GROUT THE CASING INTO THE BEDROCK. - - DATE:- RECEIVED BY: ISSUED BY: q n 1.c ' 1ill-`Y fLG LLQ r_Q_f/ ( - 1 bh {�1`il k.��.Pry KLI '( v h x'12") S DATE: j L _ Manch 20, 1992 F�p GSE HW EH. P`PS HEALTH AUTHORITY APPROVALS Mun.icipat ity o4 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stkee-t P.O. Box 196650 SEWER &WATER Anchorage, Alaska 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 27; BLock 2; Scimitar #2 ROBERT SHAFER, P E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-121 1 SEWER &WATER Request you issue a permit to dltiU a new weU on the ne6eneneed INSPECTION pupen,ty. As we .in4o4med you in a letter dated February 20, 1992 the weU serving this property has been contaminated with eoPi4onm bacteria. ENGINEERING STUDIES AND REPORTS Yesterday I tatked to Dan Bo.Ptu o6 your oU6iee 6or an update on the anea-wide water 5ampf ing being pe L6onmed .in the anea 6or nitna.tes and coti6onm bacten.ia. Dan in6ormed me that p4e2im.inary results indicate wells drawing Unom a shallow aqui6eA in the anea have high nitrate WELL INSPECTION levels. There6ore, we propose the new we.0 to be dkiUed through an &FLOW TEST ,impermeable soil layer pjrior to eonsideking any water encountered. Once this water .is encountered it wile be tested 6o4 coti4orm bacteria and nitrates. These %esu tz witt be submitted to your o66iee 6m approval prior to completion o6 the weU. SITE PLANS I6 you have any questions on require additional .inUormation 6or your, review, plese contact us. ROAD DESIGN Sincerely, solLresT ROGER J. SHAF R, P. E. RJS/gm PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER. ALASKA 99577 __�...T�_.--�--------__. -- - - ---�. _ . ,i // _ 11_ / �.�/J J/ .- v . .. ( \ c_ � � /!.. `,•� 1 �. / I� � - qt - � a � 1 � I � ,t b � � � � r, Ii�I ice' � \\a J �' � � V' � � `,; y' � '7 MUNICIPALITY OF ANCHORAGE P • Dc artment of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #Lf �i l- 1J2-`�`� HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 27• Bloch. 2: Sc,i-m,itan Subdiyi6ion 02 — Location (address or directions) NHN Tutwan Peteu Cheek. Ala3ha (b) Property owner AHEC #117247 Telephone: (home) Business561___1___07900 Mailing Address 520 EaAt 34th, Anchanage, APaAc a 99503 (c) Lending Institution NonthPand d4nntgagv Telephone 694-7872 Mailing Address 11491 0,Pd 0foop 141qhwaq., F(7qfo Rjuo),. APaA�a 99571 (d) Real Estate Company and Agent TACK WHTTF COMPANY/Ral(baha PlUtteigd n Telephone (19.4- (e) Mail the HAA to the following address: (or check here IN, if hold for pick up.) List contact person and day phone number below: S 9 S ENGINEERING/694-2979 17034 Eagle. RivuL Loop Road, Suite 204 Eagle Riven, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Q Number of bedrooms 3 3. WATER SUPPLY Individual Well ER Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [,� Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 Telephone S & S FiVGINEER Address 1734 Eagle River Loop Road No. 204 Eagle River, Alaska a / Date / `'� ~~� 7 .ppb✓ +y -T ;tel A. Pwke F ee o+ 00 A �pRO FS35\0�I„`ate 6. DHHS APPROVAL Approved for bedrooms by 7 ✓ / '�~-- Date //Z Approved Disapproved Conditional Terms of Conditional Approval V&W(= %fig a��v�-r ,�s;c/�� �'�v�/�� /,u ��«✓� /�c�v�(i-c �/u// �/� �(.�// �/s� /111"a>G &3,2 i /(lrrl C -.\-C: e 0 /Q /JY�/, , //'/ ice � � / ✓r�G� L' /C� ( dVi- J / 111 m, arr1;)(1v// b 4IJ- v�e CAUTIONI The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) '- Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: t A. WELL DATA Well ClassificationNti I ��, ��'i� f=Wyrr�i If A, B, C, D.E.C. Approved (Y/N) Iva Well Log Present (Y/N) —1 Date Completed - / .3 ( Yield Vffi Total Dept h_2__�: Cased to JAL_ Depth of Grouting Static Water Level Q2 Pump Set At Casing Height Above Ground r � t Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) L Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Se tic/Holdin Tank on Lot D / P 9 / ; On Adjoining Lots / Oo To Nearest Edge of Absorption Field on Lot / t ; On Adjoining Lots /00 .t To Nearest Public Sewer Line — j To Nearest Public Sewer Cleanout/Manhole 60-4 i To Nearest Sewer Service Line on Lot / L) `f` X Water Sample Collected by `..J d 45 64! Date —�� � INET -- Water Sample Test Results -';:>yl ! ! S J5) c torch — &AcatP rl_VA _y-.eo,t Comments B. SEPTIC/HOLDING TANK DATA Date InstalledSize 10009i4l No. of Compartments Standpipes (Y/N) V—Air-tight Caps (Y/N) T_ Foundation Cleanout (Y/N) 1 Depression over Tank (Y/N) L) _ Date Last Pumped (— q Pumping/Maintenance Contact on File (Y/N) N ; for N�J� Holding Tank High -Water Alarm (Y/N) 0.1A Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Property Line To Water Main/Service Line 0 4- To Building Foundation To Disposal Field i To Stream, Pond, Lake or Major Drainage Course Comments `e,.7' E.ntf c- t4Nj� p uvvn,rp(A T_ 72-026 (Rev. 7i8a) Front Page 1 of 2 C. A13SORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design ( 2erJc. Date Installed Length of Field Width of Field (g c7 r Depth of Field r r r, Gravel Bed Thickness Square Feet of Absortion Area !S- 'I Statndpipes Present (Y/N) Depression over Field (Y/N) A) 1 Date of Last Adequacy Test Results of Last Adequacy Test S5 C,f-© ✓y_� j�� Ipowr� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ((O To Property Line _ r r To Building Foundation To Existing or Abandoned System on Lot N% ; On Adjoining Lots � yo fi To Water Main/Service Line ( p,1` To Cutback (if present) /J 111 To Stream, Pond, Lake, or Major Drainage Course (rte 1 - To Driveway, Parking Area, or Vehicle Storage Area �;2 5 C:nmmFntc D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effgc, inspection. & J ENGINEERING y <• Signed 1A 34 r�,_gle River Loop Road No. 204 Company Eagle River, Alaska 99577 dy •r.9 Date g 5i �• J ♦. a as. MOA No. r _� �' 1 3 9_ Receipt No. S—�%' 7dy Date of Payment 12 _0 6 V Amount: $ /% - C-) Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 I J ,a f Y! �Oee ell�•1 h. Y- 4 F` CHEMICAL & GEOLOGICAL LABORATORIES' OF ALASKA, INC. �' _ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 googP7Oa ES FEDERAL TAX ID q 92.0040440 ANALYSIS REPORT BY SAMPLE fox Work Order # 18664 Date Report Printed: DEC 11 89 @ 14:01 Client Sample ID:L27 B2 SCIMITAR S/D 42 Client Name S & S ENGR PWSID :UA Client Acct SNSENGP Collected DEC 5 89 @ 17:10 his. P.O.# NONE RECEIVED Received DEC 6 89 @ 16:0 his. Req 1{ Preserved with :AS REQUIRED Ordered By : ROBERT SCHAFER Analysis Completed :DEC 8 89 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGR Released By T 4/1 2) Special Instruct: Chemlab Ref #: 8793 Lab Smpl ID: 1 Matrix: STATER Allowable Parameter Tested Result Units Method Limits NITRATE -N 5.5 my/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT -Greater Than lAPPLK IVT FILLS OUT UPPER TAI ONLY Time / L Date Property O',vne, `i C��/yJ _� ��/,//J /, /j Phone? Mailing Address j /� 1 J: r; /// G ., ;".. / taJ G/ = fly! /- r!7%i`�- /� � ,_...� Zip Code / / , Buyer A. //1 /j /V Inspector Address.7Lz z Zip Code 0 Lending Institution /// 1" :,-/ (/ /-/ /,r/% ,/,/% - Phone Address `-. e % _ Zip Code Realty Co. & Agent ���//J;t i ---. /jO X- l - Phone :/ j -���L'I;l1l IC I/ Field Notes I_ I, _,--; �� i_�Jrr__ (' Address�� /5U C/ /J� �P �li l�<'/( - �' � / // � Zip Code % �� U�}�., MUNI IPALI OI' AN ' CHORAG �� Legal Description j ]�J��,. l _' y.� Street Location ]2:z1/ zCC17 •C� Ji Type of Residence C-0Single Family I ❑ Multiple Family No. of Bedrooms �&11& ❑ Other Water Supply individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( ) DISAPPROVED Sewer Disposal O individual Year Individual Installed:/J / 71Public Utility When Connected to Public Ut'ility: ❑` Holding Tankk ( ) CONDITIONAL APPROVAL' OTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN RE INITIATED. imen IC��L Date Time / L Date Time - . ( Date r e� ) -a f -- Time Date Inspector Inspector ij ('1 Inspector 0 Inspector Field Notes I_ I, _,--; �� i_�Jrr__ (' MUNI IPALI OI' AN ' CHORAG �� L'EPT CI ENVIROF:.,�,V�AL PRO)`r:: •C� Ji fIO[` I APPROVED BEDROOMS 1 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE A _ - _ BY: Soils Rating Date Sewer Installed Well To Absorption Area r Well Log Received I Well to Tank - , / Septic Tank Size 7 ra ADEQUACYTEST WATER AND SEWER INSPECTION WELL I NSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK January 18, 1984 Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 REFERENCE; Lot 27; Block 2; Scimitar Subdivision ROBERT A. SHAFER CIVIL ENGINEER 6942979 At the request of Dynamic Realty the water system located on the referenced property was clorinated. Upon completion of clorination the system was taken out of service for a period of 2.4 hours. The system was then drained down until the static level of the water in the well casing reached the pump. Continued flow was permitted until no chlorine residual remained in the water. At this point water samplb_'s were taken at the kitchen sink. The static level of the water in the well casing was permitted to regain its normal level and a water sample was taken from the well casing. Water samples were also taken from the residence on both sides of this property. The results of all these tests were satisfactory. If we may be of further service, please do not hesitate to contact US. ' Since jv., SHAKER, P.E. RAS/ss cc: Dynamic Realty ATTENTION: Dirk SRB 196X EAGLE RIVER, ALASKA 99577 5. LEGAL DESCRIPTION -- DATE RECEIVED INSPECTION APPOINTMENTS �7 0 1 1 -vi %A ci r u� TIME TIME TIME 6. l-YPE OF RESIDENCE - ) _ 01 /t -"Vs DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ^ s j/✓1 � TY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF i! ; tj:I & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI6NVIP,QNNILN1;=.1. i ;.ojT c,rION 825 L Street - Anchorage, Alaska 99501 *ATTACH WELL LOG. A well log is required for all wells drilled ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RE CE i V L D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 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', I r �T PROPERTY RESIDENT (If different from above) - ONE 2. BUYER PHONE 1/�--\'t V\, C; �-7,77y"1 MAILI GA DRESS cY v vy" I - -a nCt+nl 3. LENo G INSTITUTION_ PHONE// y'"Yi ir�_.�� C"'G� C"� c-�V 1 V� C� ��f/J �rGi Vl01 Z"'�t MAILING,PDDRESS _ 4. REALTOR AGENT PHONE MAILING ADDRESS `— t/�G ��t C. �.. r err ey ✓� — 1 r-� I �R cJ I l l- N r� _ 11 1 --Ai A e _ 5. LEGAL DESCRIPTION -- s ._ �/ Z �7 0 1 1 -vi %A ci r u� STREET LOCATION Tru 11.ye--t.-,r 6. l-YPE OF RESIDENCE NUMBER OF\BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SPPPLY INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY_ depth (attach log if available.) 8. SEWAGE SYSTEM /DISPOSAL 1�1 INDIVIDUAL/ON-SITE** ' YEAR ON-SITE SYSTEM WAS INSTALLED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 44 :�.S CJ '7 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE a NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX e� 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified__. PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED S3 EWAGE DISPOSAL SYSTEM [L]INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified . PERMIT NUMBER DATE INSTALLED d _ 9S INSTALLER ❑Septic Tank or ❑ Holding Tank Size: /000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption AreaSewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must a cc pany certificate) ❑ DISAPPROVED DATE � ^ � 1/`tUj BY 11 nen tn." n/791