HomeMy WebLinkAboutFISCHER BLK 1 LT 4B-1Fisch
Block I
Lot 4B- 1
#015-292-40
Permit Number:
Tax Code Number:
Work Type:
On-Site Water and/or Wastewater System
Permit
OSP141347
01529240000
SepticTank
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: September 03, 2014 to September 03, 2015
Design Engineer:
Subdivision: FISCHER
Site LegalAddress: FISCHER BLK 1 LT 4B-1 G:2537
Owner/Address: MURRAY RODRICK P DEC OF TRUST
MURRAY RODRICK P/TRUSTEE 10251 OUR ROAD ANCHORAGE AK 995076540
Site Mailing Address: 10251 OUR RD, Anchorage Lot Size in Sq Ft: 21618
Total Bedrooms: 2
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters '~5.55 and 15.65 and the State of Araska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Lhe c ' _ , ~--
~'~rovisions:
1. Confirm that a foundation cleanout exists or have one added,
2. Double opposing clean outs after the tank will be added.
3. The As-built Inspection Report will not be approved until the 1984 DEC Class C to tank waiver is
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) ~. c~ .'o ~ ~ c ~i' At ¢/~ ~ h V Day phone
Mailing address ~.~1 ~A~ ~D . ~C.~P~
Legal description (Township, Range & Section) b~,S~ ~ ~¢ Id , T
Lot Size 3 f & ~ ¢ Sq. Ft. Number of Bedrooms ~
APPLICATION IS FOR:
([] all that apply)
Absorption Field []
Septic Tank []
Holding Tank ' []
Privy []
Private Well []
Water Storage []
APPLICATION IS AN:
TYPE OF DWELLING:
Initial [] Single Family (SF) []
(w/wo ADU)
Upgrade []
Duplex (D). []
Renewal [] Multiple Dwellings []
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
( 'g- a ure'(~C"pr(~p~rt,y::;~ner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_9-1-12.doc
Rod Murray
10251 Our Rd
Anchorage, Ak 99507
Attn: On Site Water and Wastewater Permitting
Please consider my application for a septic tank replacement. My current septic tank has a partial
blockage going into the tank or in its first baffle. The current design and type has been problem free for
> 30 yrs. I would like to replace the septic tank using the same septic tank size and type, in the same
exact location.
Copies of pertinent maps, waivers and certificates of construction are attached. The original and
copies of pertinent maps, waivers, and certificate to construct are housed on the 6th floor of the State
building on 555 Cordova St, Anchorage..
The following companies (licensed and bonded) I have used already to determine the problem(One
Stop Services) and evaluate the problem (Garness Engr. Group}.-receipts are attached- Once a permit is
issued I plan to use Wilco to buy and replace the tank along with Garness to inspect verify the depth, fill,
etc.
Please let me know what else I may do to expedite this permit, my family and I are VERY motivated to
get this problem resolved. Also a health issue.
Sincerely
D' S'l= A N C E F R O'-M 'S E P T , C VE',~ i' 0 5 ¢ L A SS "C"
0 2 51 Our R'd
WEL~
jg~2.7 ft.
WELL
OUR ~RD.
Lo.f 48 ¢ t
LO.~ 4 A. -
.56.7
WELt_
~"~..
SEPTIC VENT
~. ,,. ~, Municipality of Anchorage
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650
ANCHORAGE, ALASKA 99501
INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL
~4>~ LOCATION
PHONE(S)
SEPTIC TANK
NANUFACTURER CAPACITY IN ~ALS
MATERIAL U~'-'4'4v"F"~'~ #0F COMPARTMENTS
INSIDE DIMENSIONI _
LENGTH ~ /WIDTH I DEPTH~
SEEPAGE SYSTEM
[] TILE DRAINFIELD
NUMBER OF LINES I LENGTH EACH I TOTAL LENGTH
DISTANCE BETWEEN LINES TRENCH WIDTH
DEPTHS: FI LL
TILE TO GRADE BELOW TILE FILL ABOVE TILE
E~EEPAGE TRENCH OR [] PIT
W DT. LENGTH
~ [] LOG CRIB
[] RINGS- DIA.
FILL MATERIAL DEPTH
DEPTH
TOTAL EFFECTIVE ABSORPTION AREA'~' ~'_ . SO, F'I
CLA~Tth3N
WELL
I DEP~T~~'''''' PIPE MATE.IAL
INSTALLER
REMARKS
DATE f~-~'~'~.~ ~"~PPROVE D B~
72-012 (9/77)
PERMIT NUMBER
LEGAL DESCRIPTION ~
FROM~ DISTANCES .
SEPTIC SEEPAGE SEWER
TANK SYSTEM LINE CESSPOOL WELL
WELL
SYSTEM DIAGRAM~,~ [
_LOT;
E~LOCK: SUBDIVISION*
K£N' ¢OMPAN
WATER WELL DRILLING
PUMP SALES & SERVICE
(907) 243-?,~v~ ~ ~6~1 LINDEN DRIVE
KEN Jf./,H~i$~l A,',iCHOR/~G£, ALASKA 99502
September 24, 1977
Randy Foltz
Our Road
0' to 15'
15' to 21'
21'to 22'
22' to 40'
40' to 85'
85' to 110
110' to 120'
120' to 189'
WELL LOG
Silty Sand
Gravel with silt
cobbles
gravel with gray silt
brown silt and gravel ( drills open 5' to 10'
glacial till(gravel with gray silt binder)
gravel with brown s~lt
hard pan ( drills openbut slow, course gravel
with gray silt
189' to 200'
200' to 215'
215' to 230'
230' to 252'
252' to 253'-6"
253'-6" to 165'
265'
cobbles with compact gravel
course gravel and brown silt
Brown san~ (wet) no open drives hard
gravel and brown silt
Large boulder (pulled casing back and
Blasted...Rotated casing 180 degrees
gravel and brown silt
clean sand and gravel ( water bearing)
12' head
water bailed 2 hrs. at ~ five GPM
Set test pump and test pumped two hrs.
at six GPM
Bottom stable drawdown nil...very clean
Total casing 267'-0"
~ Dr$.w D~wn N/A
feet
feet
Per Minute ' 10
Total Peet of C~sing 300
Tyne Material ,~rilledf
0 feet
to 267 Exlstin~ W~ll
267 feet
tO ~80 Fractured Boulder
280 ~eet
~O 300 Worn Crave1 w/${nd
S.R.A. lox 1553 H
Anchorage ,Alask~
PERMIT NO.
RPPL I CANT
LQCBT I ON
LEGAL
i-,1kll"...t Z C: Z F"RL I TV
,DEPARTMENT
AND ENVIRONMENTAL ~ECT
I
ON
ANCHORAGE, AK
264-4728
Of4--SZ TE SE~4ER
WELL AND
( 77940 )
~.~RNDY FOLTZ
OUR RE.TM
L4-B E,K t
SRA BO,'< t745-C
F I :,L. HER_,,'--/B~
F"EF~' '~ ~. T
LOT _Iz..E 47400 SQLIBRE FEET
TYPE OF =,UIL RB_,ORE, TIuN SYSTEM IS: TRENCH
MAXIMUM NLIMBER OF BEDROOMS = ~ Z;
SOIL RATING (SQ FT,-BR,~- 85
THE ~EQLIRED SIZE OF THE SOIL ABSORPTION SYSTEM I_.
C"EPTH= tF_'~ L E~'-,~G T H= 22 6 t~ Ft"'.-' E L C"EF'TH= E,
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF B 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 qIN FEET).
SEPT I C T RNI<] S I ZE= 100~-3 r:--j~[_Ll_a~-~__.-- ~-
PRCt.(RGE F'LRNT C~P]- !
A FA_.KAGE PLANT WRY BE INSTALLE[:, AT THE PERMITTEE"S OPTION ~UBJEuT TO THE
FOLLOWING uCNDITI' ' r ION_,C.
1. EITHER R CLRSS I OR II NSF RPPROVED PLRNl WRY BE INSTRLLED
2. R CONTINUOUS NRINTENRNCE RGREEMENT IS REQUIRED. IF R MRINTENRNC:E
RGREEMENT IS NOT KEPT CURRENT YOU HRY BE REQUIRED TO ENLRRGE THE SOIL
RBSORPTION SYSTEM RND/OR YOU ~IRY BE SUBJECT TO PROSECUTION.
TWO ( 2 ) I [-.ISF"EC:T I CBNS ARE RE L-~I_I ~[ RE[:-.
BACKFILLINm OF ANY _,b_,TEM WITHOUT FINBL INSPECTION BND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND 8NY ON-SITE SEWAGE DISPOSAL SYSTE~ IS
±00 FEET FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLM. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
RVAILABLE TO INSURE PROPER INSTALLATION.
F E~:F1 IT E~:F'IRES C. EC:Ef-IBEE: -~:1.. :."LL~77
I CERTIFY THAT
1: I RM FRMILIRR WITH THE REQUIREMENTS FL]R EN-~ITE SEWERS AND WELLS RS SET
FORTH 8V THE MUNICIPRLIT9 OF RNCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2; BEDROOMS.
...................
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
LEGAL DESCRIPTION: ~" ~.~Q.~,~e..'C ~0~,
10
12
13
14
15-
17-
18-
19-
20-
/-
1
3
COMMENTS
SOIL~ ~.OG
PERCOLATION
TEST
SOILS LOG - PERCOLATION TEST
PERFORMED BY: J~1'~(~'-
72-008 (6/79)
Lq+ Ltl ~\~,
SLOPE
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
6
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE . , ; * (minutes/inch)
TEST RUN BETWEEN ' ET AND . -- FT .
CERTIFIED BY; ~ ~, :
October lC, 1977
Mr. Randy Foltz
Anchorage, Alaska
Subject; Percolation test for sanitary sewer systems Lot
~ischer Subdivision, Anchorage, Alaska.
Dear Nr. Foltz
At your request of October 6, 1977, I conducted a percolation
test to determine th~ seepage rate of the soils overlying the
lower Sandy Gravel ~n the subject lo~t.
This percolation test which was accQmplished on October 8, 1977,
consisted of an 8 inch diametsr hand auger hole of ~ foot depth,
bored into a i foot dee~l~bench cut into the side of the original
test hole, then filled with water and the seepage rate measured
and tabulated over a 1 hour period.
The percolation test hole was located 18 inches from the side
of the original test hole and the soil types encountered were
confirmed by an inspection of the sidewall of the adjacent
original test hole to insure the test was run~in the appropriate
soil types.
The percolation test was run in a test hole of 4 foot total
depth, of which ~he upper ~ feet ~e~lc~as a SN-~L and the lower
i foot consisting of a SN type soil.
An accompanying table shews the percolation rates and includes
a cross sectional sketch of the test hole.
I appreciate the opportunity to~ again have been of service to
you. Please contact me~i~cyom~have ~uy questions regarding this
percolation test.
Very truly yours,
Box 191, Star Route A
Anchorage, Alaska 99502
(907) ~44-9150
Attachments: Table of percolation rates, including sketch
of test hole.
~c: Dept. of Health & En~dronmenta~ Protection
'October 8, 1977
~[r. Randy Foltz
Lot 4B
Fischer Subdivision
Anchorage, Alaska
PERCOLATION TEST
TIME ET IN CHES DROP RATE
13: 27 Start 3.0" Start Start
13: 29. 2 6.0" 3.0" 0.67
13:31 2 ll. 5" 5.5" 0.36
13:35 4 16.5" 5.0" 0.8
13:40 5. 21.5" 5.0" 1.0
13:45 5 25.0" 3.5" 1.4
13:55 10 30.0" 5.0" 2.0
14:00 5 32.0" 2.0" 2.5
14:05 5 33.0" 1.O" 5.0"
14:27 22 38.0" 5.0" 4.4
TOTAL 60 35.0"
S6il types
firmed by an
inspection
of the side ~OL£----~
of the adjacent
original test hole.
NOTE:
(1.7 average rate in
minutes per inch)
~-~_.---~. ~-~_~--0.0' GROUND SURFACE
NOTE: H°le'filled with wat'~~
~to 3~0" below~encha~t~
.s~artlef pe~c~l~tiO~
'test. Pereol~tio~ test
~ hole located 18" away
· ~om aide.o~original
~Z
157~
Ra~y Foltz Property
Lot4B'~
Fischer Subdivision
Anchorage, Alaska
Not to scale
Distances are approximate
and have not been measured
by ~urveying methods.
The top of the test hole
has an elevation approximately
6 feet less than the floor of
the basement.
No. 1
10-3-77
0rga~ics & 0rg.0'0'
Silt, with trace
to some Gravel, bm,
loose, moist.
-- 4.0'
silty S~nd,~' with trace~;[
to some Gravel, bm, '
loose, ~moist.
(S~)
Gravel, width
scattered cobbles,
grybrn, moist, loose.
(GW)
(NO WATER TABLE
14.0'
Test hole logs represent soils
encountered on Lot 4B, Fischer
subdivision. Randy Foltz Property.
Michael B. Bergmann
Consulting Geologist
'Anchorage, AlaSka
October 3, 1977
Mr. Randy Foltz
Anchorage, Alaska
Subject: Soils investigation for sanitary sewer system; Lot 4B,
Fischer Subdivision, Anchorage, Alaska.
Dear Mr. ~oltz
At your request of September 30, 1977, I conducted a soils
investigation at the proposed location efa sanitary syste~
on ~he subject lot
This investigation, which was accomplished October 3, 1977,
consisted cf the inspection of a test pit, that was dug by a
backhoe to the depth of 14 feet.
The topography of the let is generally moderately to gently
sloping to the east. Resulting in the ~leor of the b~sement
being approximately 6 feet in elevation above the top of the
Test hole.
The soils encou~s~red in the test pit are graphically shown
on the accompanying test hole log. ~hese soils cohsis~ of a
sandy silt to silty sand of 7 feet in thickness overlying a
sandy gravel.
No water table was encountered.
An accompanying sketch shows the subject lot with
location of the test pit in relation to the house
linss.
the approximate
and property
I appreciate the opportunity to be of service to you. Please
contact me if you have any questions regarding this soils
investigation.
Very truly yours,
Box 191, ~tar Rou~e A
Anchorage, Alaska 99502
(907)3~-9150
Attaobme~ts: Drawing of test log with location sketch.
xc: Dept. ef Health & Environmental Protection
(907) 243-2282
KEN JOHNSON
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DR/LL/NG
RANDY FOLTZ
10251 0UR ROAD
ANCHORAGE, ALASKA ( 346-3776 )
RE, Water Well Lot 4 B Blk i Fisher Subd.
STATENENT
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
SEPTEMBER 18, 1985
Cut hole in casing and install existing pitless
Set pump to 294 ft. ( in line check valve 42 ft above
pump )
65.00
Test Pump well
STATIC WATER LEVEL 265'( T0C )
TINE GPM DRAWDOWN
RE~L~RKS
1544 6 266-6
1550 6.66 266-6
1600 6.66 266-6
1610 6.66 266-6
1620 6.66 266-6
Good Recovery
( 18
in. ) Dirty brown
Clearing
clearing
Clean & Clear
Glean & Clear
Sound hole ( tag bottom with pump )
Total casing 300 ft- 0 in.
Well depth 298 ft.
Set pump in pitless at 296 ft. ( 2 ft off bottom.
Hook up v~ell seal & splice in UF 12/3
Adjust pressure switch to 36# in 54# out.
Cycle pump several times
Four Houdfs
.......... $ 26o.oo
Material,
i i"X 3/4 Flare Brass ..........
I 1" inline check Brass ..........
i Sanitary well seal & conduit ...
32 ft. One in galv. drop pipe
34 ~. 12/3 Sub. pump cable ,...
6..00
15.00
4O.OO
41,92
17.68
BALANCE DUE
Tank test existing pump
See attached sheet
$ 445.60
$ 475.60
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~-~ Z'3,~OL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
I L '/51 FI cH£,
I
Location (address or directions) '= :',
(b) Applicant Name ~'-~V'~0~// J='OLr*?:Telephone: Home C/~ Business ~
(c) Applicant is (check one): Lending Institutio,.nJ~ Owner/builder ~[ Buyer []; Other [] (explain);
(d) Lending Institution '~':; / . Telephone__/
· Telephone ~
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single~Family ~[ Multi-Family[]
Number of Bedrooms ~--
Other
'~ I ,{ '
WATER SUPPLY
Individual Well ~' Community [] Public rl
Note: If corem unity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite,~ Public [] Community[] Holding Tank []
Note: If comm unity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVID~G INSPECTIONS,
TESTS, FILE SEARCH, A 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
Address /~-~'~ /'(~- --~-~'--'-'-'-'-'-'-'-'-~"~/'~ ~-~'~
/!
Date I?,, v
DHEP APPROV~ ,'2,, ,/~ , / ..~
Approved , ~ , Disapproved Conditional
terms of C r;diti ma App 0v,
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work,
Page 2 of 2
72-025 {11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~'~ /~
WELL DATA
Well Classification
Well Log Present (~'~,N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit ~/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
!
Date Competed ,~/~-, ~/77 .t/'~?/F/~d
~R/ ~ ~ TE if A, B, C, D.E.C. Approved <Y/N)~
Cased to -30~) / ~/~
Depth of Grouting ,
~ ~,% / Pump Set At ¢~¢/¢~
Z, ~ / Sanitary Seal on Casing ~N)
Depression Around Wellhead
[ O0/'~'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
K -I T ;/CLIC ; Date
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course /~O
SEPTIC/HOLDING TANK DATA
Datelnstalled [q/.~O//~7 Size
Standpipes ~YN) Air-tight Caps ~N)
Depression over Tank (YG
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
O ' -/-
No. of Compartments 2.,
Foundation Cleanout ~--¢~4)
Date Last Pumped . ~.-///.?//~2.(~'
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ,,~ ~
To Disposal Field ~.~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
.Date Installed 1~,!/2.(?/1
Width of Field ' ! J
Type of System Design
Length of Field .2_ ~.
Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot JV'/,,~
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Standpipes Present
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots /¢~)
To Cutbank (if present)
100'¢-
Comments
D. LIFT STATION
Date Installed Dimensions ~
Size in Gallons
Manhole/Access (Y/N) _
"Pump On" Level at j,~//j~~"PUm~vent (Y/N)
High Water Alarm Level at
Tested for ~'~
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
** Check Permitted Bedroom Rating Against NAA Request **
I certify that I..h av,~ ~ h e.e.e.e.e.e.e.e.e.~ k.e~d, ~ve.r4if ied,.o r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed q. U//~'~.M~/~*~ Date I ~-//5/~~'
ReceiptNo. ~¢~:~ - d;:C3 [ %
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MUNICI~ALID' OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
ALASKA ENVIRONMENTAL
CONTROL SERVIa, INC.
1200 West 33rd Aven~l~, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
UNICIPALITY OF ANCHORAGF----..
HEALTH AND ENVIRONME~PROTECTION
Street, Anchorage. Alaska 99501
#2:
264-4720
Date Received: March 15, 1978
Time #3: Time
Date Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: First National Bank of Ketchikan
Mailing Address: 811 East 36th Avenue 99503 Phone:
2. Property Owner: Randy/Kathleen L. Foltz Phone:
Mailing Address: Star Route A Box 1745C 99507
276-6911
3. Legal Description: Lot 4B Block 1 Fischer Subdivision
4: Single Family Residence: (x~ Number of Bedrooms: Possible five
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit #
Construction
Individual Well ( ~ Community/Public System ( )
Depth of Well Well Log on File
Bacterial Analysis
( )
Sewage Disposal System: On-site System ( ~x Public Utility
Permit ~ ']~ Installed ~1]~. Installer
Septic Tank Size ~.~C/'~ O~c~, Manufacturer ~e.~e~.Lw_.
Absorption Area ~ Soils Rate ~ Material c~
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
MUNICIPALITY OF
Department of Health and Environmental Protection
' 825 L Street, Anchorage, Alaska 99501
264-4720
. . -
-:~Request for Approval of Individual Sewer and Water Facilities
Property Owner: Randy Yoltz and Kathleen L. Foltz~
Mailing Address: SRA Box 1745-C Anchorage 99507
Name of Buyer: ssme
Phone: 3 9-3398
Mailing Address:
Nilone:
Lending Insti'fht~oh%{~'k~::'F~rst National B~nk of Ketchikan
Mailing Address:811 East 36th Avenue Anchorage 99503 Phone: 276-691.1.
Realtor/Agent:
Mailing Address:
None
Phone:
o
Legal Description: T~+ )!-B: Block
Street Location: NHN Our Road
Single Family Residence: ~x~ Number of Bedrooms: ~nished
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply:.. *Individual Well ~x)
If Individual Well, well depth
If Community System, name of system
Public/Conm~unity System ( )
8. Sewage Disposal System: *'~On-site System (~x Public System ( )
If On-site System, date of installation:
~ DEPT. OF HEALT &
*~o~: A welZ log is reqni£ed on ALL wells drnle~V~c]~-~T,~,~:no~
~ an adequacy
** If on-site sewer system is over two{2) years 'l ~ ~97~
test is required by this department.
A fee of $25.00 must accompany each request~fore processing
can be initiated. ' CEIVED
3/77
Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 4B Block 1 Fischer Subdivision
Comments:
Af fadavit Aitached: .~)
Approved:
Disapproved:
Letter Attached: ( )
Date:
Department Worksheet:
