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HomeMy WebLinkAboutFISCHER BLK 1 LT 4A-1Fischer lock I Lot 4A-I 015-292 -42 J' i~ i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 N-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~RADE MAILING ADDRtSS Absorption DISTANCE TO: I ~ Z Manufacturer Materiel No. of compartments  Liq. capacity in gallons IF HOME.DE: inside length Width Liquid depth , ~ Well Dwelling PERMIT ~ O Z DISTANCE TO: ~ DISTANCE TO: /r~ ~' Trench ~g~ ~ NO. Of lines / Length ~gch line Total length of lines Distance ~,.,n lines ~O inches < ~ Type of crib Crib diameter Crib depth Total eff~ti~ absorption ~rea m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth ~ Driller D~stance to lot bne PERMIT NO. ~ DISTANCE TO: ' Building foundation Sewer line Septic tank Absorption area(s) OTHER INSTALLER 72~013(Rev. 3/78) DEPARTMENT OF HEALTH AND ENVIRONMENTAL F'ROTECTION ~ 825 L STREET, ANCHORAGE, AK g9501 264-4720 CIg--SITE SEWI-]R PERM IT PERMIT NO: DATE ISSUED: 8505 15 08/19/85 AP F'L I CAN'T: .ADDRESS: [;ONTACT PHONE: RANDY FOLTZ 625 WEST 5TH AVE. ANCHORAGE, AK 99501 2776685 LEGAL DESCRIP: SUBDIVISION: FISHER LOT: 4Al BLOCK: 1 SECTION: 15 TOWNSHIP: 12N RANGE: 5W LH] SIZE: 1.5A (SQ.FT. OR ACRES) MAX BEDROOMS: 2 Listed below are the options ayailable to you in designing your ~eptic system. Choose the option that best Fits your site. TF<ENCH BED ~.J. DRAIN DEPTH TO PIPE BOTTOM (FT.) 5.0 4.0 4.0 GRAVEL DEPTH (FT.) 5.0 0.5 5.5 I[)¥AL DEPTH (FT.) 10.0 ,4.5 7.5 GRAVEL WIDTH (FT.) 2.5 14.0 5.0 GRAVEL LENGTH (FT.) 25.0 27.0 27.0 GRAVEL VOLUME (CU. YDS.) 12.8 14.0 20.0 rANI::; SIZE (GALS) I~000.0 ** 1~000.0 ** 1,000.0 ** SOIL RATIHG (SQ. FT. /BR) 125 125 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am tamiliar with the requirements 2. 5. Eor on-si{e sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA codes a~d regulations, and in compliance with the design criteria of this permit. I will adhere to all MOA and State of Alaska requirements for the set back distances From any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. I understand that this permit is valid ~or a maximum of 2 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, ]HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOI BE APPROVED WITHOU] AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: ISSUED BY RANDY FOLTZ DATE: DATE: M UNICIF'AI_ITY OF A IgCHOI~AGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 DATE ISSUED: 08/19/85 ~ ~ ~ ./. ' Al)DRESS: 6~ WEST ~TH AVE. ~ ~ ~ ,, LEGAL DESCRIP: SUBDIVISION: FISHER LOT: 4A BLOCK: 1 SECTIO~: 15 TOWNSHIP: 12N RANGE: 5W LO~ SIZE: 1.5A (SQ.~T. OR ACRES) MAX BEDRQOMS: ~ ~ ~ ~i:ted below :re the options available to you' in dmsigni~youp,~e~[~ ' TRENC~ / ~BED ~i DRAIN DEPTH TO PIPE BOTTOM (FT.) 4.0 I / 4~ U l) 4.0 GRAVEL DEPTH (FT.) . 4.0 ~/ 05 ~ 5.5 TOT2L DEPTH (FT.) 8.0 V 45 U3 7.5 GRAVEL WIDTH (FT.) ~.5 15.0~ . ; ~ ~.0 GRAVEL L'ENGTH (FT.) 3~.0 gO.O ~ -~g.O~ GRAVEL VOLUME (CU. YDS.) lo.* 16.7..~ / IANI:, SIZE (GALS) 1~000~0 ** 1~000.~* ** TAN}:. MUST HAVE AT LEAST TWO COMPARTMENTS 1~ [ I I certify that: 1. I mm familiar with the Pequipe~ents for on-site sewers and wells as ~et ¢oPth by the Municipality o¢ Anchorage (MOA) and the State o¢ Alaska. 2. I will install the system in mccordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 5. I will adhere to mil MOA and State ~¢ Alamka requirements ¢o~ the set back distance~ from any existing well, wastewater disposal system.or public sewerage system on this oP any adjacent or nearby lot. 4.I understand that thi~ permit is valid fop a maximum of 2 bedrooms ~nd any enlargement ~ill require mn additional permit. IF' A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, ]'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ~I~NED __~_~ ................ DATE.:' __~__/_~_~___~__ - ' AF'~L ICANT: ~A~i I S~JUED BY ~ ......... DATE: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: I 2 3 4 .-.~, 5 6 7 8 9 31 12 13 14 15 16 17 18 19 2O COMMENTS Township. Range. Section: SLOPE SITE PLAN WASDROUNDWATER S% EN~OUN?E~ED? ~ IF YES. AT WHAT DEPTH? Depth lo Water After Moniloi'ing? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (mmules~mch) PERC HOLE DIAMETER FT AND FT PBRFORMEDBY: AF:(.5 ST ~'~' aZ4 ~'~?~'~'~ .-~' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF~T ON THIS DATE. DATE: F'~ ~-~MUNICIPALITY OF ANCHO~ ]~.~ ! '. · ~.. h and Environmental Prote · '- Fourth Floor West , ,! 825 L Street i,~~~~/Mnchorage, Alaska 99501 279-2511, X 224, 225 INSPECTJO~ REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MATERIAL __ LIQUID DEPTH , NUMBER OF COM pA RTM ENTS ~r-'-.,~ · LIQUID CAPACITY.__ GALLONS. sEPTIc TANK: DISTANCE" FROM Wrg~..Jt~;FT~'Z;MANUF^CTURE R. , INSIDE LENGTH INSIDE WIDTH DISTANCE FROM WELL -"'"'- FOUNDATION._~'~ ! ~- ~ O~ Lines .... / D~$TANCE ~ETWErN L~r~ES UCPTII Or ,,L,LR DEPTII: TOP OF TILE TO FINISH Gt{ADEO------/ MATERIAL 6EN[A,H TILE ~IN. ABOVE TILE __% · TOTAL LENGT3;I / NEAREST LOT LINE__.~,<_~ OF LINE '~/~'~-* TRENCHWID,H_*~J~N. TOTALEFFECTIVE IN. sEEPAGE PiT: DIAMETER OR WIDTH LENGTH DEPTH Log Crib Rings BUILDING FOUNDATION__ Crib Size: DIAMETER~ DEPi'It DISTANCE FROM: WELL 'TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: ~,J/(~ Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: # of Bedrdoms: Installer: Remarks: L-ii I~C I,IR F::I F'I.qCH~'F' LFfT .c.,12EE 47j. F~9 SIT!LIRF-:;E FEET T'VFF nF qCl!i. FIF:~C~RF:]'IOi'I _'E,',r"_z..qEM IS: TRENCH r.lc~h:TilUM hlilH'::',h"F' Eli-- P:Ff':,F. tOi31,t'~; := ':. SOIL RFITING ,,'SC! F f..'EtR)= :!25 T~qF' Pr:,-!I!TP'EF., '-3t?E F~F THF ?4'~IL RE:'gOF-"F'TtON L--;'¢:E, TEIq IS: THE LENGTH ,'IN FFE'f) I]F THE TFENCH OR [:,F~'FIINFIEL[, THiC I_EHATH C, IHEi'J:_~IOfi lttL' F,P.-~:'Ti-i I-*F ~::1 TREf',ICH L-I~-~! F'TT ].q ]HE [.,TSTFP-~CE E:E'f!..iEEi'I ]HiE :51JRFPlCE OF THE THERF iS fJI]l SET NID'FH FI]~ TH'-. t'~F.'A..,'F! F)EF']-H IS THE I'IIi".IIHUi'I r,EPTH OF GRFIVEL E',ETHEFN THE OUTP'I~i.L. F'IF'E F. F'R'-_:~;R~'-,.~' F'LFIdT MFI'-r' E:F IN'--,TFd.I..E[, RT THE PEIqi'.ITTTEE'% OF'TIOI'; SIIE:.TEC:T TO THE TI-.{ I-'] ,:: :.--:-: ':, ] I'-{:---.F'EC:I' ]' ,:,1'-.I:--_--; F-IF-ti:.? J.-'E:F;,I .I T I~IE E-', F':~:-:~'[;TI I,TI;F, i',F- Fti'.l'¢ 'q"r'L--.TEl'{ I{[THOLIT F]i"lRI TN:~PEF:FION ~N[:' iqFF'~-:I'.rv't~'L.E:"¢ THI~ r)Fl:A[q'Tfl~{'l'[ i.'{[LI. F',P; SI{8.IEI_-:T TO F'J(;CISE'-C:LITICIN r,!TNTf'I;JH [:,ISTtqr-h-:E F:ETHEEN R I.FLL Ri'.lE, RN'T' ,-~N--L--.,TT~-- SEI,IiqGE I-.,~'RFt~E.t'~L Sh.'STEH I~ !P,q FEET i-Vi;::' ~ F'PIVFFrE HELL nE: 2OF~ P'EE'I FL-IR FI ~:'JlE:I_~C: l,lrE[_l. T I-:FR'TfF'¢ TH,ql- :i' T ~11 ~i:~MTI_IFtF*' NITH THE RE,-!JTIYEI,iFNT_'E, FFff;: CffJ-~;:[TE SEHEP; ~t4r, NELLS RS SET FF, FTtl P.'¢ THE I'IUNIE:IPRLIT'¢ IJF RNCHOP¢C-~. 2' 7 I.I;I_L ~t.l'~:~Fd !. THE _.,=:,TEM IN RCCOPF:'RNCE HIgH THE CO'DES. I U~;r,FKSTF~*4D TklfqT ]H~" Fm4-SITE '5FHFR S'¢S]EI'{ HR'¢ RFOLITF'F: EfiLRRGEP1ENT IF THE ~A G,"~6.TER ANCHORAGE AREA BORO':'",~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 ./ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MAILING ADDRESS LEGAL DESCRIPTION .PHONE DISTANCE PROM WELL LIQUID CAPACITY MATERIAL L'~:~/~}I{~'"'$ / ~ '- GALLONS. INSIDE LENGTH NUMBER OF j/ COMPARTMENTS '/q~ L,OUID INSIDE WIDTH. DEPTH NEAREST LOT LINE SEEPAGE SYSTEM: SEEPAGE PiT: I L,N'NG MATER,Al ~'4/f/U7 12/4"~'-5 D,STANCEEROMWELL ISV' ~ ~ , , BUILDING FOUNDATION J ~ / TOTAL EFFECTIVE ABSORPTION AREA ~ALL AREA) ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL. NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE 10 FINISH GRADE ., FOUNDATION. DISTANCE BETWEEN tINES SQ. FT. LENGTH OF EACH LINE, DEPTH OF FILTER MATERIAL BENEATH TILE , NEAREST LOT LINE TRENCH WIDTH TOTAL LENGTH OF LINES .IN, TOTAL EFFECTIVE IN. ABOVE TILE WELL: r/PE--~)£, I1~ DEPTH' 7 LOT lINE ,~L~ I NEAREST t'~ ! SEPTIC · SEWER LINE /e'"' ~-' ., TANK DISTANCE FROM BUILDING FOUNDATION· // ! SAMPLE , NEAREST /~.~j-/ SEEPAGE ---,--~ . SYSTEM J~ /~O , CESSPOOL ~ , SOURCES DIAGRAM OF SYSTEM DISTANCES: ' DATE GREATE~ANCHORAGE AREA..)ROUGH IIEALTil DEPARTlqENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY LOCATION OF INSTALLATION L~'r" q A V/ ,SEEPAGE PIT V/ ,DRAIN FIELD. mANCEOT"ROUGH I P TO BE NSTALLEO DY S .Z PERCOLATION TEST RESULTS I~ ~ /~1 ANTICIPATED DATE 0F COMPLETION BELOWTO BE PILLED OUT BY HEALTH DEPARTMENT . PHONE NO. ,OTHER. THIS IS TO SERVE AS j~ ~ I_£& J'~ , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO RE SERVED , SEPTIC TANK SIZE , "~'"~ TYPE ~c'~? SEEPAGE AREA ~-~'~',.J~/ TYPE DIAGRAM OF SYSTEM DISTANCES: balth Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described//sYSJem ~ in accordance with said code. ct.~l.~ ~ .~ .ATER ANCHORAGE AREA BOROUC. n~ HEALTH DEPAf;TMENT 3~7 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE Legal Description: Lot~yq'~lock / ~ubdi~isi'0n This Fc~m RepoPt$ a: Soxls' Log ._~-'~ -}~ercolation lest I~pth Feet sf Soil Cha~acterlstics Was G~ound Water Encountered? If Yes, At W~at Depth ~ Location Sketch LEGEND AND NOTES Found ofticlol monument. Found 5/8" rebar. · Found I/2" robot. 0 Sol I/2" rebar. ( ) Indlc~3fe$ Dafum of Record. o Well ~ Se~ic venl ~ Power pole PREPARED FOR, BLOCK ONE -" I LOT 4A-I .' Randy Foltz S~A Box 1727-F Anchorage~ AK SCALE, l" - 50~ ~A5 ~'*~" 4~Z~-S ,~ ,'~ AS-BUILT SURVEY I . ~p~V, PLscher SubdLvlston ~o~ 4A-I and 4A-2 G~ock One Field Book NO..82-33 (907) 243-2282 KEN JOHNSON KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE 30 YEARS ALASKA DRILLING 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 JUNE. 19, 1985 RANDY FOLTZ 10251 OUR ROAD Anchorage, Alaska ( 346-3776 ) ( Wk. Rel Lot 4A Blk I Fisher Subd. WATER WELL LOG 2?7-6685 ) Pump breaking suction..Pull pump.. 3 ft 7 in. water in well. Dig up pitless & patch casing & back fill..Nove rig on hole. Sound hole., Tools dragging badly 35 ft. off bottom ( 235' ) Tools run free on bottom ( 263' +- ) commence drilling.. Casing drives hard at intervals. 263 ft to 274-6 ft 274-6 ft to 2~5 ft 275 ft to277-b ft 277-6 ft to 279-6 ft 279-6 ft to 280 ft Course gravel & light Brown silt Weep in 5 ft H20.. Bail dry Formation same..Casing very tight Weep in 14 ft H20..Bail down to 2 ft. Clean water bearing fine gray & med. 20 ft head Test bailed 10 GPM 2 ft. Drawdown Good recovery ..Bottom stable Total casing 281 ft 0 in. sand Dig hole and install pitless..Set pump.. TEST P~P DATA Static water level 260 TI~ 1100 1200 123o 13oo 14oo 15o0 15o5 ( Toc ) GPM DRAWDOWN REMAPdfS 10 261 Dirty 'brown..Pump at 276 ft 10 260-10" Clear 10 260-9 in. clear 10 260-9 in. Clean & clear 10 260-9 in. Clean & clear ( sparkles ) 10 260-9 in. " " " " Shutdown Returned to. Static immediat&l~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal.de, scr pt on Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real EState Agent Mailing Address; Expiration Date: //' '30-/c0 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3~ -;I'YPE OF v~A-T~-R SuPpLy: Individual Well Individual Water Storage Community Class 6~ Well Public Water System Day phone /CA eye/ 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (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 or 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 Certificate of On-Site Systems 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 files and from my investigation and inspection, the on-site water supply and/or wastewater 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 ~/~'~/>~< ~'l/~/~_¢_/'/~/¢ Phone Address ~-,c~',~ ,E, Y7,'//,¥< t¢/o Engineer's Printed Name //-¢~ 7-7-/1-¢ ~, ,¢' ~ //~z¢/'~¢¢~-,,/* Date bedrooms. DSD SIGNATURE [/'"/' Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: WATER AND Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Z ' ~ O --/© Municipality of Anchorage Development Services Department Building Safety Division On*Site Water & Wastewater Program 470OEImore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type. ~''~. Date completed Total depth ~.~ ft. If A, B, or C provide PWSID # Sanitmy seal (Y/N) Cased to ~. ~'O ft. FROM WELL LOG Parcel ID: OfF- ). q.)..- Date oftest ~'--,/'~- ~'~"' Static water level '~. ~' / ff. Well production ! ~) g.p.m. Well Log (Y/N) Wires properly prot~, ted (Y/N) Casing height (above ground) AT INSPECTION ~-/7-/o g.p.m. WATER SAMPLE RESULTS: -co,form-O co~n~/100rnL N,rate ~')- ~{m~L Arsenic: ~1~ ug/L date of sample: ~'.--~-lO Other bacteria. Collected bT. B; SEPTIC/HOLDING TANK DATA Tank'Type/M~erial 57-~-~---// ~a ~?~e~,-~''-~ gal. Number of Compartments · ;~ ~*~ ,- ~ ', , ~,.~,,~atiod'~., ,a~._ t (Y/N)/v Depression over tank (Y/N) ,/V~ ~~~[I~D DATA Len~h -'~' .. Width Tot~ depth {~ ~ Eft. abs~ion ar~ Date of a~quacy test ~-17-[~ R~ults (Pass/Fail) ~. Fluid dep~ in absorpt~n field ~fore test ~ "in. Water added ~5;al. Elapsed Time: ~ min. Final fluid depth in, A~orption rate >= Any rejuvenat~n treatment (past 12 mo.) (WN & ~) Date instatk~ci ~;~- q- ~'q Cleanouts (Y/N) High water alarm (Y/N) /v"~f System type '-/'~,,,~c./,, Grovel below pipe. '.$'-" ft. Depression over field -'~ For ~ bedrooms New depth ~;)"in. ~.~'~ g.p.d. ,,~/'0 · Ifyes, give date D. UFT STAT,O. Date installed,.f.,,,'"' Size in gall~,~"'"'- "Pump on~l at.. in. "Pu~l~ level at . D~ ?/Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot ~.[),-.~ in. Manhole/Acc~) i . High~er aiarm level at On adjacent lots ~'"' *' l$'-0 ' 'Public sewer main Sewer/septic service line ~"'~ ' Animal containment areas., On adjacent lots Public sewer manhole/cleanout ~ ,"~'"'~ Holding tank Manure/~nimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~' / Property line + [O e Absorption field ~- 3o ~ Water main ~ ~r Water service line "f"~ ~ Surface water 4-/o~ ~ · Wells on adjacent lots ~- [~o, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line )'- 5/t Building foundation /"{~" Water Service line 7 ~ ' Surface water +"~ ~ Oriveway, parking~ehide storage Curtain drain ,,4/',,4 Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name/~'~f~ Date COSA Fee $ Date of Payment Receipt Number (Rev. 1 t/05) Waiver Fee $ Date of PaYment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196550 Anchorage, AK 99519-5550 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 101179 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4A-1 of Fischer subdivision. This inspection revealed a nitrate concentration of 8.29 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS Reft# 1104054001 Client Name Quarels, Johnson Printed Date/Time 08/30/2010 9:28 Project Name/# Fisher Sub L4A-1 B1 Collected Date/Time 08/09/2010 10:15 Client Sample ID Hose Bib near pressure tank Received Date/Time 08/09/2010 11:05 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/16/10 08/17/10 KDC Waters Department TotalNitrate/Nitrite-N 8.29 0.100 mg/L SM20 4500NO3-F B (<10) 08/09/10 AYC Microbiology Laboratory Colony Count 0 col/100mL SM20 9222B A (<200) 08/09/10 DLC Fecal Coliform 0 col/100mL SM20 9222B A (<1) 08/09/10 DLC Total Coliform 0 col/100mL SM20 9222B A (<1) 08/09/10 DLC ,SCA Z £ t" '- 30' 69.7 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED P~T ARE NOT SHOVVN HEREON, ~K AS-BUILT NO CORNERS SET THIS DATE I hereby eertkc~' that I have per£omed a Mo~.agee's spection of t~e following described prope~y: _ ~chorage Recording Precinct, ~, and ~at the ~prpv~- menfs situated thereon are with~ ~e p~p~ no~ overlap or encroach on ~e prope~Y lying a~aeent ~ere- ~, that no imp~vemen~ on prope~y lying adjacent ~ere~ en~oa~ on C~e premises in question and roadways, tran~ission lines or other visible easemen~ Dated a~ ~ehorage~ Alaska ~D WALATI<,A & ASSOCIATES Engineers and Surveyors : 08/23/2010 13:32 8686770 APLUS PAGE 01 A+ HOME SERVICES INC. 7501 E. 140th Avenue Anchorage, .Alaska 99516 345-1890 CUSTOMER Associates INVOICE if 38062 Rlock Lot DATE o8-19-I0 DESCRIPTION AMOUNT $160.00 /6o. Gallons l)~ Septic Leach Area ~ Holding Tank PROBLEM AREA ~ CALL FOR MORE INFORMAT[ON NEEDS TO BE DONE AGAIN IN 6 MONTHS Good Shape ji~ Sludge buildup on bottom Jim cap missing or [] Cut standpipe to 1' above ground needs replacing Standpipes ~)'~"e'"~rime Floater on top Needs Septictdne 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 ~'-- ,'?.-~,.~. -x~/'.,~- Naa #/'~"-(~ 1. GENERAL INFORMATION Complete legal description Lot 4A-I~ Block Ii F,U~ch~t Subd. iul,sJ_on~ Location (site address or directions) ** Property owner Mailing address Don Gl~6 ~ Bonr~e Long Day PhOne 346-1082 10215' Ou.,'t Roa. d Ancho~tage, A~.a6ka 99515 Lending agency Mailing address Day phone Agent~tcn La~.g¢~'.~ SACK WHZTE C0MPANv Day phone 76~-3114 Address 3201 C S~e~, S~ 100 Annotate, Ak. 99503 Unless othe~ise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~PE OF WATER SUPPL~: 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. ~PE 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. Se STATEMENT OF INSPECTION BY ENGINEEI~ 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 Mu.nicipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone 5 C. 5 =NO Address .... ; ~.,~le River Loop Road No. 204 -~ :~le River, Alaska 99577 Engineer's signature DHHS SIGNATURE ~" Approved for ~'~'~ (~'.) Date y',/ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~'--- ~'~-~J~ Date 1 The Municipality of An. chorage 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 reduirements. 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~,~ ~ ~ - ~; L2',I~)c..~'I ~ ~"_~-~.r Parcel I.D. A. WELL DATA Well type ~f A, B, or C, attach ADEC letter. Log present (Y/N) [/ , Date completed Totaldepth 2. ~:;;~0 Casedto ~ ~' Casing height Sanitary seal (Y/N) L~ Wire's properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level g.p.m. ADEC water system number Ip- 14 - ~- Driller ~-~J~!~ Septic/holding tank on lot Absorption field on lot Public sewe{main Public sewer service line SEPARATION DISTANCES FROM WELL TO: I~ f ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout AT INSPECTION _~. ~ g.p..r~=~ ~_~ Ioo t~ Petroleum tank WATER SAMPLE RESULTS: Coliform -~m'~[~,~14C~+Dtu, Nitrate ~,~Jl~'~,'~'~lc.'~'b~.~ (2,~10therbacteria Date of sample: "~ - C) ~-- - ~ I Collected by: _~ B. SEPTIC/HOLDING TANK DATA Date installed ~'~- ~ ~ Cleanouts (Y/N) I.! High water alarm (Y/N) Tank size ~ _~'O ~ ~. I Compartments I Foundation cleanout (Y/N) t,) Depression (Y/N) Alarm tested (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 'Jl'~O ~ On adjacent lots I0~ ~ Topropertyline ! m -t" Absorption field :~tO 4- Surface water/drainage ! ~t"',) JF Foundation Water main/service line ~.02~ (,w. ~) ~t ao~ 2~ CONTINUED ON RACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) level at High water alarm level Meets MOA electrical codes (Y/N) · N,~ ; SEPARATIO;N DISTANCE FROM LIFT STA Well on lot On adjacent Iot~ D. ABSORPTION FIELD DATA Date installed ~ -- Z/_.., - _f~" Length '~'r') I Width ~.. s Total absorp!i'~n area ~'~ oo "~ Depression over fie d (Y/N) /,,) Results (pass/fail) ,D ~ ~ .~ Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water Gravelthickness ' ' ~'~' s Cleanouts presen~t (Y/N) Date of a.dequacy test for p J/FI If yes, give date. Soil rating ~ System type ~ Total depth bedrooms Well on lot ! To building foundation. ,~/ On adjacentlots ,"~0~'~' Surface water ./ Curtain drain. ' /~J/JAr Eo ENGINEER'S CERTIFICATION On adjacent lots I O0 t'{' Propertyline To existing or abandoned system on lot I Cutbank ~/~, Water main/service line · ' Driveway, parking/vehicle storage ar, ea I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on tha, d~f, this in~h~ct/'on · ... .... ,,~,~..~...m~ ~ Enginee~sName ~ '. - · t , ~...~ ' . ' ~ ~1,,~1~_ Date ///~/~ / ~~/~ ~;~ / '// . . ,~~ -' , .. / HAA Fee $ '~ ::~O Waiver Fee: $ Date of Payment '~' ! ~'~ Date of Payment Receipt Number _'?~.'~ I (""//~ '~) Receipt Number 72-026 (Rev. 3/9~) I~ck MOA 21 ,elUNICIPALITY 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 ~'- ~"/- ~'~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) {b) Al~plicant Name /~/~''uf~/' ' /~/--~'Z Telephone: Home ~/~' -3 7 ?~, Business ~b~ ApplicantAddress ~),Z~'~ /J ~ ~ P"#/~"~" ,&" ,~/~., (c) Applicant is (check one): Lending Institution D; Owner/builder~; Buyer []; Other [] (explain); (d) Lending lnstitution ~-le~,~L~3~'_ _~'~_.,~_ _~,.-.1~.. Telephone Address ?~-"~ ~-- ~ (e) Real ~tate Company and Agent ~. ~ ~ Address ~ ~ ~-~ Telephone ~ ~ ~ (I) ~il the HAA Io lhe Iollowing ~ddress: TYPE OF RESIDENCE Single-Family)E:~' Multi-Family [] Number of Bedrooms ~'- Other WATER SUPPLY Individual Well'J~ Community[] Public[] Note: If community well system, must have written confirmation from the State Deparlment of Environmental Conservation attesting to the legality and status, 4. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank I"1 Note: If community well system, must have written confirmation from the State Department of Environmental Conse~'ation attesting to the legality and status. Page I of 2 z~-0~s (~t~ ENGINI=ERING FIRM PROVIDINg.. ,NSPEOTIONS, TESTS, FILE SEARCH, DA ...~ AND INFORMATION As ce~ified by my seal affixed hereto and ~s of the validation date shown below, I verily that my investigation of this Health Authorily Approval shows that the on-site wa~er supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and lype of slruclure indicated heroin. I luther vedfy Ihat based on the information oblained from the Municipality of Anchorage liles and lrom my investigation and inspection, the on-site waler supply and/or was~ewater disposal syslem is in compliance wilh all Municipal and Slate codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ Telephone DHEP APPR~.VAL~'~ Approved .,~/ Disapproved ' Conditio-~a,'~' 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 S 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 Ihe professional engineers work. Page 2 of 2 72-025 (I 1154) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~-.~ MUNICIPAI-RY OF ANOf~Ar~H AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ............ TM. PROT[%'I'IO~HECKLIST ' FEBRUARY 1984 rr~v~n~'~ 264-4720 MAY 2 2 ~ Legal Description: ~ RECEIVED / If A, a, C, DiE. C. Approved (Y/N) ~"x'/Z'~/~s~'</ Yield /43 Depth of Grouting Pump Set Al Sanitary Seal on Casing~.~) Depression Around Wellhead (Y~) Well Classification Well Log Present Total Depth ~. Static Water Level ; On Adjoining Lots Date Completed Cased to __ ~?...~0 ! ~.6o" Casing Height Above Ground Electrical Wiring in Conduit ~1) Separation Distances from Well: · To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ,~///~- Water Sample Collected by / ~'*'3'** / ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot A' J4'~"~/ ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes/~Y~) Air-tight Caps Depress~on~over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~1/~' Separation Distances from Septic/Holding/Tank: To Water-Supply Well To Property Line / To Water Main/Sen/ice Line Course Size 75~ ~5/'/7-- No. of Compartments Foundation Cleanout Date Last Pumped t/J,~' ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026($t,,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed c~'' ~' Width of Field Square Feet of Absorption Area Depression over Field (¥~ Results of Last Adequacy Test Separation Distance Item Absorption Field: To Water-Supply Well To Building Foundation 4~'~' Lot /~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~ / Standpipes Present~q) Date of Last Adequacy Test To Property Line '~// To Existing or Abandoned System on ; On Adjoining Lots ~'"'~' "'~ TO Cutbank (if present) '~///"~ Dimensions LIFT STATION ~ in Gallons~"'.-~ "Pump On" Level at ~'~ High Water Alarm Level at Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) Tested for ~umping Cycles during Adequacy Test, Meets MOA Check Permitted Bedroom Rating Against HAA Request I certify that I hay~,che, c~ed. v~rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~- · //"l,~,r.~---- Date Company /~'"'~ '>'' MOA No. Receipt No. .'~ '~::>'~ ~;;)-~ .-~ Date of Payment . ~'"~.~' --~L~'~ Amount: $ ~ ~ Page 2 of 2 ~ ~ -- ~,/6 ~ec2~ - ALASKA ENVIRONMENTAL CONTROL SERVIC~''~, INC.* 1200 West 33rd Aven~. Suite B ANCHORAGE. ALASKA 99503 Phone 561-5040 Joe ~7 :~'/~/ ~/~' / SHE;T NO. CALCULATED BY CHECKED BY ICALE ALASKA 'lROllillfllTAL cOrITROL August I, 1985 Alaska Department of Envlronmental Conservation 437 E Street Anchorage, Ak. 99501 Attn: Steve Eng RE: Proposed Class "C" Water System, Lots 4Al and 4A2, Block 1, Fischer Subdivision, Anchorage, Alaska Dear Mr. £ng: On behalf of Randy Foltz, we request'approval for a Class "C" Water System on the subject lot and a waiver for setback to 123 feet from a septic tank and 135 feet from an absorption pit. The well was originally drilled to 263 feet. A two-bedroom log cabin located on Lot 4Al used it as a private well. The well was extended to 281 feet on June 19, 1985, to provide sufficient yield for two houses. &.ECS calculates the well is adequate for two residences if 300 gallons of storage capacity is provided (data attached). The well has a sanitary seal and the wires are enclosed in a conduit. water sample from the well was tested and found to be free of coliform bacteria (July 19, 1985). Surface drainage is away from the yell. A Well logs for two neighboring lots are attached. Static water levels are 229 and 260 feet. Sitly soils are indicated approximately 8 to 215 feet. This depth, along with the silty soil strata, will prevent surface water and contaminants from reaching the aquifer. All other septic systems are outside the 150 foot radius of th'e well. A percolation test (attached);fdentifies, . suitable area for a septic system .to serve future constructiod'On We recommend that this ~e1'i be'approved, as a Class "¢" well with 300 gallon storage required. (See'calculatlons), and that the 150 foot isolation distance be waived accordingly. If you nee~ addltional information or if there are any questions please do not hesitate to contact me at 561-50~0. Please notify us upon completion of review. I · I~ro~erty Owner Mailin0 Addre~ Buyer Address APPLIC'"NT'FILLS OUT UPPER HAI"-'ONLY JPhone ;~t~ 21-)! Phone Ztp Code Phone Zip Code Street Location ~/:\ ~\.~ ~"-, \ Type of Residence Single Family [1 Other Water Supply Individual [1 PubliC Utility Sewer Disposal Public Utility Holding Tank ATTACH WELl. LOG, A well log Is required for ail wells drilled since June 1975. For wells ~'illed prior to that date. give we depth a tach log If available)· When Connected 1o Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REC~JEST BEFORE I~OCESSING CAN BE INITIATED· Time Time Time Time °ate oa,e Date Da,,-.-...., BECEi VED ¢ ~ ) APPROVED BEDROOMS °OONDITIONSOF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* BY: Soils Rating Date Sewer Installed Well To ADsorption Area Well Log Received Well to Tank Septic Ta~k Size ALASKA I IiUIRODm DTAL CODTROL S RuICI $, IDC. AUGUST I 1983 MUNJCI;:'ALJTY OF ANCHORAGE ENVIRO,".::,~CNrAL P~,O TECI'ION RANDY FOLTZ AUG~ ~t~ SRA 1727 F ANCHORAGE AK ''0' RECEIVED SELLER - MICHAEL BARCOTT SUBDIVISION-FISHER BLOCK-1 BUYER-RANDY FOLTZ LOT-4A ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 300 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 375 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 375 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 2 BEDROOM HOME, SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME THIS 2 BEDROOM HOUSE, OF 750 I8 ADEQUATE FOR 1200 J~¢sl 33rJ Au~nu¢. Su,t~ B · Ancbraqe. Al~sk~ ~S03 · (907] 276-1361 July 27, 1983 Mike Barcott SAA Bokx 1729-E Anchorage, AK 99507 Subject: Lot 4-A, Block 1, Fisher Subdivision Approval for the individual sewer and water facilities cannot be/.lranted until thc following items have been completed: [9~t~xpose the well for our Inspection to determine proper ~ construction~ also to insure minimum distance requirements ore met between the well and sewer system. The septic tank pumped ulth a receipt submitted to this department, }4 ! An adequacy test needs to be performed on the exlsttn8 leaching area, This test will determine if the system is adequate accordinE to National Standards, A listing of private firms performinE the test is enclosed, This report ~ee~s to be submitted to this office for our review. ~ ~ a this Department for a retnspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720, Sincerely, RP29/eJ/E2 Enclosure Robert C. Associate Pratt Environmental Specialist GREATER ANCHOP~AGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February, 24, 1977 Time of Inspection 9.'00 a.m Date of Inspection 2-25-77 T.NB REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. l. Approval requested by: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 2. Property 0wner: Robert/Susan Irwin Phone: 276-6300 264-2122 Mailing Address: Star Route A Box 1727D 3. legal Description: Lot 4A Block 1 Fischer Subdivison 4. Location: See directions on the back of white form 5. Type of facility to be inspected Singel Family 6. Well Data: No. of bedrooms 2 e A. Type Individual C. Construction ~/O.,t~-~ ~ Sewage Disposal System: On-site system B. Depth 265' D. Bacterial Analysis A. Installed 1969 B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages 1. Type of Inspect[on: 2. Property Owner: MUNICIPALITY OF ANCHORAGE /~ NJTY OF ANCHO~OE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~EPT. {~ H~ALTH & 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ~-J~IRONN~EHTAL PkOTECTION REQUEST FOR APPROVAL OF INDIVIDUAL SEWER end WATER FACILITIES CMRO VA Mailing Address: -~ BOX FEB 1977 FHA ~CONV. 5. Name of Realtor or Agent: ~J I~ D ~ o Mailing Address: Phone:. Legal Description: Lo'r' Location: 7. Type of Facility to be Inspected' No. Bdrms. o Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well ~ ~' Individual o Sewage Disposal System Type of System: Public Utility If Individual, date of installation Ic~¢~ Individual (on-site) 72.003(3/76) · iPage 2 of two pages - Re'-~'~t for Approval of Individual ~-'tr & Water Facilities Le.U.a.1 Description Lot 4A Block 1 Fischer Subdivision ~ ~~foroneyear fromdate signed Greater Anchorage Area~ough, Department of Environmental Quality DIAG~M OF SYSTEM certify that the informationlcontained in this request for approval to be a true and accurate representation of thelsubject sewer~and water facilities and these facilities are operating satisfactorily. SIGNED EQ-034 (1/74) Date i~rch 2, 1977 / First t~ational Bank. o~ Anchoraga ~~~ / Toot Office ~ox 220 ~Iortgage ~ $~chorage, ~as]m 99510 / The %;ull conut~ction aaa water ~ality of the pro~y is sail;factor. The =~ ~yut~n was to ~ inadu~ate after c~uct~g ~ ~uorption rata tuft. This de~i~rtm=nt would grant a temporary approval~/f- ~e preset see~ge pit. The s~cificati~s for leach line ~e as fo11~u~ Length: 20 feet Depth: 10 to 11 feet Gravel depth: 6 feet A pernit is required fro~ this office before uny constructiun begins. Co~.o~]eration should be given to the l~ssibility o~ tnter~,~pumping until tha u~ra~u Is completed. If thora ara any further questions, please contact thio o~fico at 279-2511, extendion 224 or 225. Sincerely, Les i{. Buchholz, R.S. Sanitarian cc~ ~obert Irwin ~tar Route A Box 1727D 99507 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Approval/~ec uested by: Mailing Address: Property Owner: Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Phone: Mailing Address: ~3.' Legal Description:~/~.~ ~4. Location: ! Type of facility to be inspected Well Data: A. Type ~. C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: E. Disposal Field: No. of bedrooms B. Depth '~~- D. Bacterial Analysis (~1 - ~"- '- ,?~ B. Installer Size 7(~. 2. Manufacturer 1. Absorption Area ~00~l 2. Material Total length of lines Distances: / , Sewer Lines A. Well to: Septic tank /J~ , Absorption area /J7.'~/ Nearest lot line J/<9~ , Other contamination B. Foundation to septic tank .~/ , Absorption area ~z/o / C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages "Page' 2 6f two pages - Req, "or Approval of Individual S ' Water Facilities ~gal Description Comments Approval ,Valid for one year from date signed Greater Anchorage Ar~a Borough. Department of Environmental Quality DIAGP. AM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCtlORAGE AREA BOROUGH.. Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA 2. Property Owner: Mailing Address: Io~ 3. Name of Buyer: l-~. ~. ~1~ Mailing Address: 4. Name of Lending Institution: Mailing Address: h~ 4 ~ 5. Name of Realtor or.Agent: Mailing Address: FHA __ CONV ~? Day Phone Day Phone Phone Phone 6. Legal Description: ~o~s HA 4 ~F5 Location: /),,~ ~. (u:~rm~ 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individua], number of dwellings If Individual, depth of well ~oo 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. ~ Individual presently served Individual (on-site) EQ-037 ()/74) CASE NUMBER: S-754~3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET DATE RECEIVED: March 28 SUBDIVISION OR PROJECT TITLE: Lots 4Al, 4A2 Fischer Subdivision COMMENTS: COMMENTS DUE BY: 1984 /' April 13, 1984 / _1/