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HomeMy WebLinkAboutTHOMAS L BOYLE BLK 2 LT 13AThomas L 0 Boyle Block 2 Lot 13A #015-283-11 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 9 Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either Is, Ib or Ic.) A.D.L. No. :,.:]IBorough subdivision Lot Block I►. 1/441 rs. section No. Township N❑ Range E[] Meridian ncl,. R;oVle 17' 2—of—ef_pr_ s❑ w❑ Ic. DISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Street Address and Area of Well Location Feet Below 2. WELL LOG Surlace 4. WELL DEPTH: (final) 5. DATE OF COMPLETION (J li Material Type Top Bottom Ir:'nnIc: 11ro}':T. cnfto D 4 6. ;0 Cable tool ❑Rotary ❑Driven ❑Dug ❑Arugger ❑Jetted ❑Bored ❑Other: tir']Tn -.11' soft. 11. 26 color. nodiuri 2L Y' ?.USE; C1 Domestic ❑public supply ❑Industry ❑Irrigation ❑Recharge ❑Commerical ❑ Tssl well ❑ Other: :1•r Uf.CP:.e °'.its : rrde fe (ir^'d r•7 ; frrev colo2 std V. r: to r:]tG1'At CCI• S. CASING: ❑ Threaded ❑.WNdad diem. 6 In. to 67 11. Depth Weight 17 the./ ft. dram. In. to— ft. Depth stickup 11. r111uviwn: bro'in ::nc costa lie, 56 "117 -re" Colort Co�7n:,cteu ar.( 5t, 6? 9. FINISH OF WELL:O nOn Once Type: Diameter: SIa1/MHh BIss: Lenphi Set b lsosn 11. and ft. Backfilling Gravel pack enlorp z th aacr: 62 67 t0. STATIC WATER LEVEL: 10 to. ❑ Above or below land surface Date Equipment used: rand line 11. PUMPING LEVEL below land surface and YIELD 55 it. .etN, 2 hn. pumping�O g. P.M. _ftafter hre. pumping _p.p.m. 12.611OUTING Well Grouted: .❑ Yes ❑ No Material: O Neat Cement ❑ other nriturrl. 13. PUMP: (If ovallablo) His ^� Length of Drop Pipe ft. capacity p. P.M. OF HEALT 18 ❑ Subm. ❑ Jet ❑ Csstrlfical ❑ Other EN'VlkC; LLNTAL P: rECT1ON 14.REMARKS: WATER E C E I V E D 16. WELL CONTRACTORS CERTIFICATION:•`R 15. Water Temperature ❑ f ❑ C This well was drilled under my Jurisdiction and tole report Is tree to the best of my knowledge and bellef; Dore Drillin, AA 758 Registered Business Name Contract License Number Adar...• T 3 `- ox 7530 Chul_,irLy ,".IL. 99%7 Signed: �/' /`= .. �).[�—, f �'._I-r `-, 1('�t Dote: �1c^ Authorized Raprosenletive Form 02•WWR (11/61) Copy Distribution: WHITE -stale DGGS, PINK•Dritlerr CANARY'Custatner Permit_ Applicant: MUNICIPALITY OF ANCHORAGE Department Health and Environmenta]r-A-otection 825 Street, Anchorage, AK. 501 264-4720 * * * HANDWRITTEN PERMIT WELLPERMIT Mailing Address: /�2/oa /C/.✓� Location: Phone Number: '3e4 — Z/74/ Legal Description: Lp 7- /,3i¢ 2 Lot Size: Type of Soil Absorption System Is: 01 Trench: �n_ Drainfield: _0 —seepage Bed: 0 Holding Tank:y Maximum Number of Bedrooms: S Soil Rating(sq.ft/br) &( 4 The Required Size of the Soil Absorption System Is: DEPTH LENGTH. GRAVEL DEPTH�////I 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 departmer. will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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 �^* 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 systemmay re ire enlargement if the residence is remodeled to include more that edrooms. r. Signed: 1�eIssued by: Applicant �/g �y Date: �O SWP/024(1/81) 5Kt it i Cc% ANLIIUI</,L;E AHLA BOROUGki DEEP TMENT or rj:k'IRONMEt:T,,L 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For Bill and I .:Legal DescripltTo—n-Lol This Form Reports Soils Depth Enterprises -6 1 o c k _.�._S -u 00 x Feet Soil Characteristics Brown and Cray Sandy Silt 2.— 3— 4 -5 Cray Slightly Sandy Silt Was Ground Water Encountered? No If Yes, At What Depth? .Date Performed Vision Boyle Fe—r—c—oT'ation CASE # 5/23/72 7 Reading Date Gross Time Gross Time Net Time Depth to H2O Net Drop EReading E erco 1Ra Proposed T e .1nute InstaTT�atjon.- Seepage Pit Depth Of COMMENTS: COMMENTS: 30- 0 Inlet Depth Drain Field To Bottom of pit ch r Tr— -3L)v—sa---- Tnix s-tandards. square feet of drainage area 't --- T ' s. Therefore, �cannaortet-ecj�jm��7an required� 0 u is required per bedroom.. This �exceedif—� �sewa�g� we �onusl e e5 er Orme VY R. E. Car is e a a A er— . .1. u I Date. Inc MUNICIPALITY OF ANCHORAGE O Department of Health &Human Services M 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 l.D.# 'C'IS- ',1Sil-11 HAA# QQQq CIS, I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) AoT 13 A'! )fz.;r; 41 Location- ddree W direLybrtg)� .tet J ��y�T,� M1 (b) Prop ertjf o�v�kt1 "�G J • u- 1:--\w �A �.... 2a x)j.) 1EG L/ Telephone: (home) 11gle-4 , lfk (c) Lending Insfttutjon ' + Telephone Mailing Address (d) Real Estate Company and Agent ,1RE-111" SND lf?7ed Address ZGOr' c'°'e.."4 A,144 /W Telephone 7,7L -L74/ (e) Mail the HAA to the following address: (or check here' if hold for pick up.) List contact person and day phone number below: 4,ew Pits ui . 2. TYPE OF RESIDENCE Single -Family%, Number of bedrooms J- 3. WATER SUPPLY Individual Wetly Community ❑ Public ❑ Business Z74-SS99 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 (R". 7/U1 Page 1 of 2 L/3A ds- ant/c6 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 / AnG% Telephone y71—SSSS Address i✓ 33 *141, 9f>e3 Date 5-15'-8'9 6. DHHS APPROVAL Approved for slew -3 bedrooms by �"�' '-�� �Q ` �'�` f Date Approved/X' Disapproved Conditional Terms of Conditional Approval CAUTION, The Municipality of Anchorage Departmentof 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 orderto satisfycertain federal and state requirements. Employees of DHHS do notconduct inspections oranalyze 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 (R«.7/aa) Back Page 2 of 2 .r O!%.YGt of I\' MUNICIPALITY OF ANCHORAGE (MOA) \�\Qp�\�P� fi - Health Authority Approval (HAA) MSN �E� _ CHECKLIST - FEBRUARY 1984 c�vRG 343-4744 A WELL DATA Legal Description: 407-/1A AL9 Z aoyl- r I%z.✓ Z3^p JEL Z/ Well Classification If A, B, C, D.E.C. Approved (Y/N) _4LA_ Well Log Present &N) Date Completed 8`8T Yield �•�G 6PN Total Depth—Z Cased to 671 Depth of Grouting Aft" Static Water Level Pump Set At A/A- Casing Height Abov6 Ground — Electrical Wiring in Conduito/N) SEPARATION DISTANCES FROM WELL: Sanitary Seal on Casing ON) — Depression Around Wellhead (Y61 To Septic/Holding Tank on Lot �� / ; On Adjoining Lots To Nearest Edge of Absorption Field on LotJL4 ; On Adjoining Lots To Nearest Public Sewer Line � To Nearest Public Sewer Cleanout/Manhole 1 To Nearest Sewer Service Line on Lot 7 -:r7 -:rt Water Sample Collected by hr63 A *JMfJ- • Date //'" Water Sample Test Results Comments 102r21 TE -17- B. SEPTIC/HOLDING TANK DATA ' Date Installed /979 Size 7-02 /OM No. of Compartments EA• / / Standpipes&N) Air -tight Caps 19N) Foundation Cleanout (Y© rZ41cer Depression over Tank (Y� Date Last Pumped S �' /JA t Pumping/Maintenance„ Oontact on File (Y/N) ; for Holding Tank FfigtSWetei A(gr`ro y, Y ) Temporary Holding Tank Permit (Y/N) SEPARATION'fSrS ES FR013t�SEPTIC/HOLDING TANK: 0. To Water=StlppLX YV L To Building Foundation "� Teit' 9 To Property Linae---------- -�� 7" � To Disposal Field � '1 .R JCFIY .� 1V%3� j � To Water Mdl(i\rlMl. tt i To Strea Po�ri9i �pPiainage Course 7;WXI 1AM66 e/7Y ✓aV /)C/4d 724M !Ra. 7/5BI Frml Page 1 of 2. I/fr- aL d.>'� C. ABSORPTION FIELD DATA ils Rating in Absorption Strata Date tailed Width of Square Feet of Depression over Field (Y/N) Results of Last Adequacy Test _ SEPARATION DISTANCE FROM To Water -Supply Well To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present(Y/N) Date of Last Adequacy Test I FIELD: �— To Property Line To Existing or Abandoned System on On Adjoining To Stream, Pond, Lake, or Major Drainage Course . To Driveway, Parking Area, or Vehicle Storage Area Comments LIFT STATION Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments To _ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request' certify that I have checked, verified, or conformed to all MOA and HAA gu inspection. GCLC.. Signed L_— iA Company 4W Pagel Date S --ice �5 IF MOA No. OL/ �il cl'/sbAO Receipt No.. 0� 5/7 Receipt No. Date of Payment ;�.Waiver Fee: $ Amount: $ �1,�21�r> Date of Payment 72-M (A". 7/88) Back Page 2 of 2 Z�` flQ1q`on the date of this .• .. 7 w. � •••••"Engineer's Seal 0000000449 ..�..., oY Q em � CE -=11 � r _r CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 usou,owns FEDERAL TAX ID N 920040440 Client Sample ID:1.131, 62, BOTLE PWSID :UA Collected APR 21 89 4 14:10 hrs. Received APR 21 89 1 16:00 Ms. Preserved with :AS REQUIRED ANALISIS REPORT BT SAMPLE for Work Order f 12872 Date Report Printed: APR 25 89 4 12:38 Client Name : A I C S Client Acct : AIECSRP P.0.6 NONE REC D Req B Ordered By : 1. WIEN Analysis Completed :APR 24 89 Send Reports to: Laboratory Supero a r :STEPHEN C. nEDL 1)A R C S Released By : C `LIm— 2) .................................................................................................................................... Special Instruct: Chemlab Ref B: 4985 Lab Smpl ID: 1 Natri:: WATER Parameter Tested Result/Units NITRATE -N Sample SAMPLE COLLECTED BI ►.W. Remarks: Allowable method Limits EPA 353.2 1 Teets Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA. Not Analyzed LT -Less Than, CT -Greater Than 10 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATES 1. General Information Application Date Le- &d (a) Legal Description (include lot, block, subdivision, section, township, range) wi /3A BoyLG R3 K D __ SEC T12N, 222 Location (address or directions) (b) Applicants Name 5Ys-717 9 ephone - Home Applicants Address_- /2/00-F%J4GNQZ-_ (c) Applicant is (check one) Lending Institution Owner/*mii,ier =7t ; Buyer ; Other [:::I (explain); (d) Lending Institution ra NJ V" a,.4 &CA Telephone e Address (e) Real Estate Co. & Agent (1NTJ2`/ a/ Address RD S'6 n�.,D c.....,, ...i �/.•../..... __ Telephone _ SNq-- �LSoI &Iy-2300 (f) Mail the HAA to the following address: 2. Type of Residence Single -Family M Multi -Family Number of Bedrooms 3. Water Supply Individual Well 12-" Community Other (describe) %/;4,2'�� Public' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite M Public M Community M • Holding Tank l X] 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. Engineering Firm Providing Inspections Testa 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. po q -A 9/b Name of Firm Telephone_ Address /odd 3 Itzel Date • * ' M . (ENGINEER SEAL) 6. DHEP Approval �• tic. /� • �• 1;,,:E �., l i Approved for% a4!5 bedrooms By Approved X Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 r� MUNICIPAU7Y CF ANCF!oRAo2 DEPT. CF FiEALT I EW1RCt4dENTAL F,, iECT;au MUNICIPALITY OF ANCHORAGE (MOA) DEC 0 7 X984 HEALTH XMiORITY APPROVAL ( HAA) RECEIVED CHECKLIST - FEBRUARY 1984 Legal Description: Lp l 13A `�-� K A. WELL DATA R....i: r_ C c� -r-, .8 Well Classification S If A, B, or C, D.E.C. Approved(Y/N) K/A / Well Log Present (Y/N) Date Completed 8188V Yield-6'rq� Total Depth C7 Cased to ` 7 Depth of Grouting M,p NkV Static Water Level 10 Pump Set At 55 Casing Height Above Ground Sanitary Seal on Casing (YIN)e Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) Separation Distances from Well: Toweepbic/Holding Tank on Lot 1DO On Adjoining Lots Ito f To Nearest Edge of Absorption Field on Lot N/A ; On Adjoining Lots 1001 To Nearest Public Sewer Lire No NtiE To Nearest Public Sewer Clearout/Manhole (gyp Pl L= Tb Nearest Sewer Service Line on Lot 100+ Water Sample Collected By Late 12/51 SY Water Sample Test Results Comlents B. ==;E/HOLDING TANK DATA Date Installed 1974 Size AC"jO No. of Compartments ,2724tks Standpipes (Y/N) y Air -tight Caps (YIN) Foundation Cleanout (Y/N) Depression over Tank (Y/N) &I Date Last Purged 41/s!S5� Pumping/Maintenance Contract on File (YM) Y ; for [ *0 YE-AT25 Holding Tank High -Water Alarm (Y ) Temporary Holding Tank Permit (Y/N) APP. Separation Distances from Septic/Ho irg Tank W- v puJ� vj To Water -Supply Well 100 To Building Foundation (�(o �o%)*A +0.i( To Property Lire 10 + To Disposal Field N/& To Water Main/Service Lire 10+ To Stream, Pond, Lake, or Major Drainage Carie NON 6 Comments Receipt R 3' c r '., Date Paid: Amount: (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA NONE Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Depression. over Field (Y/N) Date Results of Last Adequacy Ibst Separation Distance from Absorption Field: To Water -Supply Wall To Building Foundation _ Standpipes Present (Y/N) of East Adequacy Test To Property Line To Existirg or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Lire To Cutbark(if_present) To Stream/Pord/Lake%or Major Drairage Carse To Driveway, Parking Area, or Vehicle Storage Area Camlents D. LIrr STATION N o N E Date Irstalled Dimersiors Size in Gallons _ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments Manhole/Access (YIN) "Pump Off" Level at _ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelires in effect on the date of this inspecti / Sigred Date �-� (s• rr Company MOA No. KB1/d5/s [Page 2 of 2] IL ` Orr A� y�PtE..'Sn7 ''f9 4 * 4S!7G`TNSERS ... N 2225-E 1 NE 25, 1971 2-15-84 r /0 _ 5. LEGALpSyi1 6 CuL DI �rSr �� C LLON A10CA /^C L 13 /7 DATE RECEIVED INSPECTION APPOINTMENTS NUMBER OFsSEDROOMS TIME ❑ One ❑ Four ❑ Other TIME TIME DATE ,� Three ❑ Six DATE DATE INSPECTOR ' ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR /nI ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGEF 1pD�o1VEPT. OF I—ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTINM[: T, . i ..-:TLCTION 8. SEWAGE DISPOSAL SYSTEM 825 L Street • Anchorage, Alaska 99501 INDIVIDUAL/ON-SITE" / Y Y YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY APR 141980 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED 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. PRO.P5ERrT1 Y�Ol WN�R ��/J,` f/7 C) PHONE 1 MAILING 1p 9E$IDS )eox PROPERTY RESIDENT RESIDENT lit different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. RE / R/!1(.sEN v'4)rl� �" /Y 7 PHONE MAILINGADDRESS 5. LEGALpSyi1 6 CuL DI �rSr �� C LLON A10CA /^C L 13 /7 STREET LlOUCATI 1 i4) V �� -s--re-s--re6. TYPE OF RESIDENCE NUMBER OFsSEDROOMS IX SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five 1:1MULTIPLE FAMILY ,� Three ❑ Six 7. WATER SUPPLY - N 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 DISPOSAL SYSTEM INDIVIDUAL/ON-SITE" / Y Y YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY a —. %5-C-0 a11v-y\ 4" V�S NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72 010 (Rev. h..Dt t.44CA -I I A& THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Neares[ Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 0 APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BV 74010 (Rev. 6/79) I r / 1 Mc'DONALU'S PUMPING SERVICE 2900 Boniface Pkw,4. Anchorage.,PK 99509-••-34-9-7813 December 3, 198L McDonald's Pumping Service contracts with William anti Christina Wyman of 12100 Wagner St., Anchorage, to pump their septic holding tanks once every two months or as needed. This contract is valid for two years. William Wymarf lJ!}rnt�„� Christina Wyman William M96onald Marx Enterprises, Incorporated BOX 10232 • KLATT ROAD STATION • ANCHORAGE, ALASKA 99502 EXCAVATING & LANDSCAPING CESSPOOL PUMPING AND SERVICE COMPANY May 13, 1980 Municipality of Anchorage Environmental Quality "L" Street Anchorage, Alaska 99510 To whom it may concern: This letter is to verify that Anchora.-e Cesspool Pumping will pump the holding tank for Mr. Ken Waist on Wagner Street on an as needed basis for 2 years. Sincerely, /-0z.4iu. 4 �',. Delores E. Marx Secretary MUNICIPALITY OF ANCHORAGE DEPT. OF I' =". -. cTION ENVIRONfI ':;i:,� ►hnY 13 1980 RECEIVED I r r" Municipality cipality Of Anchorage POUCH 6-650 ANCHORAGE, ALASKA 99502 (907) 278.4531 GEORC£N. SULLIVAN, MAYOR DEPARTMENT Of HEALTH AND ENVIRONMENTAL PROTECTION, Environmental Sanitation Division (2510 East Tudor Rowl August 18, 1976 Mr. and - Mrs � Trujillo -- 4.1 This department has reviewed.the property at Lot 13A Block 2 Boyle Subdivision, Wagner Road. At this time the owners have upgraded their well to the proper specifications. The holding tanks have been recorded and in view of the extremely impermeable soil, we feel that the holding tanks are allowable. We have no objection to a home of up to three (3) bed- rooms being built on this property. If there are any further questions, please contact this office at 276-2221, extension 292. Sincerely Robert P. Neale Principal Environmental Control Officer RPN/ljh k a - �Nck_�,a` a I August 18, 1976 Mr. and Mrs. Trujillo 4.1 This department has reaiewed the property at Lot 13A Block 2 Doyle Subdivision, Wagner Road, At this E�ae the o+mars wave upgraded their veli to the proper specifications. The holding tanks have been recorded A" in view of the extremely impermeable soil, we teal that the holding tanks are allowable. We have no objection to a home of up to three (3) bed- roons being build on Ulds property. If there are any further questions, please contact this office at 276-2221, extension 292. Sincerely, Robert P. Urals Principal 3nviroamental Control Officer RPN/1jh kj /S'O oJn� t4M�S) ' Ci�e.ct� I,aQ,U -�- WCt�,u. �— GIf1GNeR ST b i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL F INDIVIDUAL SEWER and WATER F CILITIES 1. Type of Inspection: MRO -VA FHA CONY 2. Property Owner: Mailing Address: 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent:_ Mailing Address: 6. Legal Description: Location: 7. Type of Facility to be Inspec) 8. Water Supply Type of Supply: If Individual, number of If Individual, depth of 9. Sewage Disposal System Type of System: If Individual, date of insl 72003(3/76) Public Utility lings presently served Public Utility Day Phone: Day Phone: Phone: Phone No. Bdrms. ndividual (on-site)