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APPLIC' NT FILLS OUT UPPER HAC`'ONLY
Property Owner
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Buyer
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Lending Institution
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Phone
Date
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Address
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Realty Co. d Agent
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Legal Description
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Inspector
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Street Locallon
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.Type of Residence
O Single Family
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MUNICIP LITY OF ANCHORAGE
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Q -Multiple Family
No. of Bedrooms
0 Other
w ter seppty
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ATTACH WELL LOG. A well log 19 required for all wells drilled since June 1975.
�Community
aCT For wells drilled prior to that date, give well depth (attach log If available). r
L Public Utility
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Sewer Disposal
❑ Individual
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C C -3 Una a Year Individual Installed:
C Public Utility
When Corrected to Public Utility:
L Holding Tank
x7} APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED '
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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MUNICIP LITY OF ANCHORAGE
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Field Notes: ��W,Z 1 C�C.�.,,
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RECEIVED
x7} APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED '
( ) CONDITIONAL APPROVAL'
DATE y ��
BY:
Soils RatingDate
of Instal. tedi
Well To Absorption rea
Well Loq Received
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Well to Tank
Septic Tank Size
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WELL RECOVERY TEST
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January 23, 1984
Ron Baker
3605 Arctic Blvd., #1469
Anchorage, AK 995U3
Subject: Lots 10 & 11, Block B, Debora Subdivision
Eagle River, AK
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° Provide a copy of your certificate to operate a Class "C" ,,/.fi
-� community Well. You should have applied for this with the y%
State Department of Environmental Conservation officer;
however, for further information you can call Mr. Nike
Mathews at 274-2533.
�`° ublic sewer is available to the above property. Prior to
„1Lub� this department's approval, the property must' be connected
V V to the public sewer and._ verification of the conne sub- /�,�,-^
mitted to this office. l,f �e
7 vle-On sf '-sewer system wi 1 eed to be abandoned anti
f.illed--wit+rdiYt. ✓�
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are: any
further questions, please call this office at 264-472U.
Sincerely, i \� .-
Cory Willis, R.S.
Acting Sewer & Water
Program Pianager
C14100/ej/E1
CHEMICAL & GE LOGICAL LABORATORIES k,.' ALASKA, INC.
TELEPHONE (907)-2794014 ANCHORAGE5633 BUS` INDUSTRIAL CENTER
—� 274-3364 .
�-» Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
�--� I.D. NO.
ir��-
Water System Name Phone No.
Mailing Address
City State Zip Code
SAMPLE DATE: r 1 Year
Tll
Mo. Day
SAMPLE TYPE:
O Routine
[I Check Sample (for routine sample t ❑ Treated Water
with tab ret. no. ❑ Untreated Water
❑ Special Purpose
SAMPLE Time
NO. LOCATION - collected
L I /1
2
3
4 I
5
READ INSTRUCTIONS
BEFORE
Collected
Y
(,J
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
'❑ Satisfactory
❑ Unsatisfactory
❑ Sample too long in transit: sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
❑ Fermentation Tube
P Membrane Filter
Lab Ref. No. Result' Analyst
I m
�J m
IUJ m .
•NO 0 Cebm.✓ 100 w W No of 0,0u1M mn,C
06.1220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1918
Date Collected �•'•••" -
a.m.
' EMS Brotn a4 morn o•--•+� ••--•••
COLLECTING SAMPLE M.ltIFN Tube Report, 10ml Tub" Peeltive/Total 100111 Purllons
Membrane Fat.ri olml, Count Collrorm/1001111
v"Incation, LT e 111ae
Final Membrane Fat" Retuee Cplform/100m1
Reported M Time. in
p.m.
°F T,11STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
„ er.eax„
ALA^� for
PUBLIC WATER SYSTEMS
A. APPROVAL TO CONSTRUCT
Plans for the construction or modification of Water System, Lots 10 & 11, Block B
(8421—FA-281) Class "C" Debra Subdivision public water system located
In Eagle River . Alaska, submitted In accordance with 18 AAC 80.100
(
by S(S Engineering have been reviewed and are
A ❑ approved.
conditionallyapproved (see attached conditions). Lot 1 & 34 Block E must be
CU� y►'s
�Si t Public Sewer. 2uPu`�`'1 CrdevefopeL�, p1cER TNF FACj'
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TITL DATE
If construction has not started within two years of the approval date, this certificate Is void and new plans and
specifications must be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Change (convect *roar no. w deecrtOtiw reference) Approved by Date
Waive horizontal separation between the well a tiic tto kg to 115 t.
Waive horizontal separation between the well �e�ch fieQd to 124 t.
LTn4..0 l.nrisnntal ,aenaration between the well & public sewer line to 62 ft.
Waive horizontal separation between the well & sewer service to 30 ft.
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
is made available to the public.
The construction of the kPaTur- SY -rc M cars f 0 1 N C3ldCk f3 PFptC7�ibfic
water system was completed on thou ti (date). The system is hereby
granted Interim approval to operate for 90 days following the completion date.
BY TITLE DATE
As•bullt plans submitted during the interim approval period, or an Inspection by the Department, has confirmed
the system as constr cted a��ppcording to th approved plans. The system Is hereby granted final approval to
or te. FTE 'T'H FACT$
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TITLE DATE
104407 (Rev. 11t"
DISTRIBUTION: 1. WHITE • ENGINEER (Complete Sxtlon C)
Z. YELLOW • WATER SYSTEM FILE (Complete SMUt C)
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