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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 1 LT 15 ANCHORAGE AREA BOk... GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM WELL ~'- MANUFACTURER~'~ t'~l ~' ERIAL INSIDE LENGTH INSIDE WIDTH ~ LIQUID DEPTH DRAIN FIELD:~. DISTANCE FROM WELL ___~_ ~ ] '~O NEAREST LOT LINE PHONE NUMBER OF COMPARTMENTS LIQUID CAPACITY ~ 6,~AL LON S, TOTAL LENGTH OF LINES__ NUMBER OF LINES ABSORPTION AREA ~'~ ~ ~;~ BI:PTI-I: TOP OF TILE %0 FINISH GRADE WELL: ~ FOUNDATION SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL EFFECTIVE IN. ABOVE TILE IN. TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION____ LO]- LINE__, SEWER LINE__ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH SEPT lC SE EPAG E TANK__ SYSTEM REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM G.A.A.B. 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I lii',l:i; ':: .F!: ;'I:::'":'T' TO OS-E Russell Oyster 694.2774 Soils 8' Foundations GED, cCHNI CAL 8' DEVELuPMENT Box 90, Davis St., £agle River, Alaska 99577 694-2774 of 68a-2280 CO. £arl Ellis 6~-22.80 Land Development SOIL LOG Performed for: Name:, ~?~/' Mailing Address: Tel. No, Legal Description:./:'~z:A"... /,- /~'~7~ /.~S~ A/~, /'//7ZZ/ZF' ~,'~-~'2-/-2r~.3' Depth (feet) Soil, ,Characteristic~ 0 lO ll 12 Ground Water Encountered: Yes No Proposed Installation: Seepage Pit ~L If yes, what depth Drain Fte~d Comments: Performed by: Date:_ W" SON WELL DRILLiI"< 1305 W. 45TH STF~EET ANCHORAGE, ALASKA ggS03 PHONE 27':)'g343 DRILLING LOG Location (address off Township, Eange, Section, if known; or distance main road Size of casing Depth of Hole_ -,3 / r~ feet Cased to ,~m~> ~ feet Static water level ~} ft. (above) ~) land surface. Finish of Well (check one) open end ( / Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at~.-~ gallons per (hour) ~inut~e~for of drawdown from static level. Date of completion ;'~ ~7 ,~tx~t?,fx,.b}- /',7 '7 7 ); hours with ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness MUNICIPALITY OF ANCHORAGE DEP1, OF HEAL'[I~ & FNVJRONMENFAL PR01ECTION RECEIVED 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D,# OSO-(; N/ - ~0 1. GENERAL INFORMATION Complete legal description Lot 15; Block 1; Mountain Valley Estates Location (site address or directions) 9370 Hiland Rd. (on Birdsong) Eaqle River, AK Property owner Mailing address Steve & Donna Bock Day phone~ 694-9371 HC85 Box 9371 Eagle River, AK 99577 Lending%gen~y ". ,. , Mailing address Day phone Agent Address'-' Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 'x, TYPE OF WATER SUPPLY: Individual well Community well NOTE: xxx Public water If community well system, provide written confirmation from State A~EC ~ttest. .'.. ing to the legality and status of system, TYPE 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, 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & $ ENGINEERING Name of Firm 17cc4 ::.g!~. ~."'::r L-~-~- ~-~--~ ~,, ~ Phone Address Eagle River, Alaska 99577 Engineer's signature t Date ///~5-/'~ 7 DHHS SIGNATURE Approved for ~-~]7~bedrooms. Disapproved. Conditional approval for bedrooms, with (he following stipulations: Additional Comments The, Munici~alit~ bf Anchorage Department of Health and Human Services (DHH8) issues Health Authority /~PPr'o,~li~edi~icates based only upon the representations given in Paragraph 5 aboVe by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-O25(Rev, 1/91) Back MOAff21 ~UNICIPAI.ITY Ol: ANCHOP, AGE I~NVIP, ONM[NTAL SERVICES DIVISION Municipality of Anchorage ,lAN 1 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division R E C E I V E D 825 L Street, Room 602 · Anchorage, Alaska 99501 · (g07) 848-4744 Health Authority Approval Checklist Legal Description: t~----'c \~ ~'~.- \ I~Y~, ~,'Vl~J~-'~ C~<~( Parcel I.D.: © -~' O ~ ~ A. WELL DATA Well type ~-~,\1~-'~.~ If A, B, or C, attach ADEC letter. ADEC water system number Log present ~) t p4 Date completed Total depth ,~ ~ I ~ , ?~ Cased to G-~ 2_2 Sanitary seal ~) '~/~¢_A Casing height (above ground) Wires properly protected.(~N) Date of test FROM WELL LOG ~io g.p.m. AT INSPECTION ,,~,o Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: i / //-,J /'~ 7 B, SEPTIO/HOLDINGTANK DATA Nitrate /. ~ 7 Collected by: Other bacteria S & S ENGINEERING 17034 E~g!- I~iver Loop RoJlIJ Eagle River, Alaska 99577 Date installed Foundation cleanout (Y/,~j) Date of Pumping ct ~1 t-. ~fl C. ABSORPTION FIELD DATA Date installed '~ ~ I ~-~ ~? ~ Lengtl~ '%7 ¢ Width Tank size \~ o Number of Compartments Depression (Y/~. ,3 ~ High water alarm Pumper _1~¢-, GJ ~q? ,,~q Soil rating (g.p.d./fF or fF/bdrm) p, 5¢/~r_- System type '77-P/ '~ / Gravel thickness below pipe 2 p~,¢-,~ .,"-Total depth 1/ Effective absorption area ~?,¢~ O,~,-~, Monitoring Tube present'N) '-/ Depression over field (Y/~? Date of adeqUacy test 2 ~2..o ~ ¢~'-~ Results ~ail) _ ~,,¢~s s' For 3 bedrooms Fluid depth in absorption field before test (in.); d)" Immediately after U/Z-gal, water added (in.): Fluid depth D (ins) Minutes later: O/~- Absorption rate L/5'~ = .g.p.d. Peroxide treatment (past 12 months) (Y/N) /,-I ~ ,3 ¢~ ¢-/3 ~u3 ^~ If yes, give date ,D ] ~ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* ~~ump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line cP On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I Water main/service line Property line I ~ ~ '~ Absorption field Surface water/drainage / ~ ~ Wells on adjacent lots /oo /''~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 1 r~ ~¥ Building foundation 2 ~"-- / Water main/service line Surface water I ~ ~ 14-- Driveway, parking/vehicle storage area Curtain drain ,~'J ~ ,~P~ //-~u~ /''/ Wells on adjacent lots /~ ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor~t_h..~,~.b._~,ems are in conformance ~ithxMO,¢ H&4 guidelines in effect on this date. HAAFee $. ~ Date of Payment ¢ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc, L a b o r a t o r y D i v i s i o n ~`~`~`~r~r~`~dr~`~`~r~dr`~r~r~`~r~r~`~d~J~Jfjjjjjjjjjj~j~ Laboratory Analysis Report CT&E Ref.# 970258001 Client Name S & S Engineering Project Name/// N/A Client Sample ID L 15,B 1 Mm Valley Matrix Drinking Water Ordered By PWSID Sample Remarks: Client PO# Printed Date/Time 01/16/97 16:17 Collected Date/Time 01/14/97 11:30 Received Date/Time 01/14/97 15:10 Technical Director: Stephen C. Ede Parameter Results POL Units Nitrate-N 1.87 0.100 mg/L Iota[ Coliform 0 cot/100mL Allowable Prep Analysis Method Limits Date Date Init SM18 4500-~03F 10 max 01/15/97 JBL SM18 9222B 01/14/97 TAV 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tek (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO, WEST VIRGINIA Parcel I.D. # 1. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~f--~l - ~0 HAA# GENERAL INFORMATION Complete legal description Mountain Valley Estates Lot 15, Blk 1 Location (site address or directions) 9370 Hiland Road, Eagle River Property owner Mailing address Lending agency Mailing address Agent Address Michael & Rhonda McGouqh c/o Realtor Day phone 694-2141 N/A Day phone Les Geisler/Don McKenzie Real Estat~ay phone 694-9035 13135; Old Glenn Hwy., Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: ';-;! ',',.1 . .'; If community wastewater system, provide written confirmation from state ADEC attesting to the legality and status of system. ~ 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER 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 inves_ti_gation 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. Phone 694-5195 99577 Name of Firm Eagle River Engineering Services Address P.O. Eox 773294, Eagle River, AK Engineer's signature Date ~/~ t/~- 6. DHHS SIGNATURE Approved for '~,~" "bedrooms. ~ ..... -' ' DisapprO'vedl ' ';~"/-':"~i"-i:;'.'-'' '/'' ':'~ ' ' :'.':.'.''i "-": ':':" i . '-. 'Conditional approval for '"'~ '"" bedroomS, ~ith the following 'stiPQlations: Additional Comments t:. I,~:lll I[I] [ ,~, ;,.~, , ~ ~ ~, ~' ,,.<.. ,-. ,, :, \'LThe M'~r~ c'~a ltv of Ahehbrage Department of Health and Human Services (DHHS) ~ssues Health Authority ',~j',~p~roval ~rtificate?~ ba.~ed only upon the representabons g~ven ~n paragraph 5 above by an independent ":'¢rSies'sional engi~l¢~ rS~istered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes alnd tl~/_e~'r'''l~ndir~ g' 'i~r~tliutions in orderto satisfy certain federal and state requirements . Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work." 72-025 (Rsv. 1/91 ) Back MOA ~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Parcel I.D. Well type ?/¢/t.//~ If A, B, or C, attach ADEC letter. ADEC water system number /'.///] Log present (Y/N) YE ~ Date completed O~/Z q/'7"7 Driller Total depth ~ ~ / Cased to ,~ ~ / Casing height Sanitary seal (Y/N) /Vf~,~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION /-/? / SEPARATION DISTANCES FROM WELL TO: / Septic/helding tank on lot Absorption field on lot /-/0(_.) Public sewer main /'//'~ Sewer service line /- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ./l/(2/,1~ /'/OL) / t¢ I'?/9 /z ~Y¢T WATER SAMPLE RESULTS: Coliform -~ Date of sample: 0 ~//~/¢ ~ Nitrate /, Collected by: Other bacteria B. SEPTIC/I~OL:t~IG TANK DATA Date installed (,~ '?//~/'? '~ Tank size Cleanouts (Y/N) ~/¢% Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping /--0/0 '~ / C~ ~[ Compartments ~-- ,,"~'(2 Depression (Y/N) Alarm tested (Y/N) /,k//~ Pumper C~ /~. ~ SEPARATION DISTANCES FROM SEPTIC/~G TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation //~ / Water main/service line ~' / ~ ~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical~ SEPARATI~...DIS~NCE FROM LIFT STATION TO: Well od lot On adjacent lots Manufacturer J~-"'"'-¢'*' Ma~nhol~s (Y/N) .~ "Pump off" Level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed 0 '~//~"/¢ ? Soil rating (GPD/Ft Length ~ '~ / Width ~ ¢ Gravel thickness Total absorption area -o (~-~,-,.,-,0Cleanout present (Y/N) Date of adequacy test 0~,,/Z-0/~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) /<///'~- System type Total depth y~ Depression over field (Y/N) ,hf¢$ ~; for ,-.~_~ After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots 7 Sudace water Curtain drain //!/¢W¢~ On adjacent lots '/-/00 / Property line To existing or abandoned system on lot Cutbank /~//A Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the, da(.e,.of this inspection. ~1 t-'gna-ure ~' : "" ' :': ~ ';' · , . ',; ,: '; ~ 't' ,.' ";¢~:FS%\'O'%..j£ Engineer's Name HAA Fee $ ~'~¢ ' ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back 1. General Inforn~tion (a) Legal D~sc~timtion~(include lo~, z.,-- MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTA~L DEPARTMEFIf OF HEALTH AND ENVIRONMENTAL PRC/I~CTION APPLICATION FOR HEALTH AIY£HORIT.Y APPROVAL CERTIFICATE Application Date ~~/~' ¢ blo~.~.~ .~bdivi%i~on, section, range ) ~/67[ //~:.7 ~:>...%~' /~2 to, reship, (b) Applicants Name ~'?//'1 ~' '~' ,_~'(~__///'' '1 < ]l~lephone Applicants Address (c) Applicant is (check one) Lending Institutkq~ ~-.--]'~; Owner/builder (d) Lending Institution Telephone Address ~'/ ~ ,, - . ~ ' T._3i~ of l~side, nce Number o~ Bedrooms Multi-Family Other 3. L-.%te~ s__uDll% Individual We 11.~5_~[ Co~anity Note: If ~nity ~e.ll system, must have ~it~n c~nfi~tion f~cm the State ~p~nt of Envircn~ntal Conservation attesting to t~ legality and status~ Is the ~11 adequate for the n~r of ~ s~cified in this U~ (Y~) 4. Is the wastewate~ dis~sal system adequate for ~e rTdm~r of ~dr~/N) [Page 1 of 2] 2--15-:84 5 o E_D_qineerinq F!.rm P~ovi_d_i~n.g_~s_pections, Tests, Data and Inforrmntion I oertify that: I hav~-~ked, verified~ or conforn~d to all ~)A HAA Guid~].ir~3s in effect on the date/'~f t~hfs.,insD~¢~ion. / Na~ of Fi~ ~lephc~ Address Signed by Date (ENGINEER SEAL) 2he Municipality of ;~cho~age Department of [~le. aJ. th and Enviro~]~ntal Protection d<~s not guarantee the continued satisfactory performance of the water_~ supply and/or the wastewater disposal system. 1]nis approval indicates that, as of t|~ validatJ.©n ~te shown aboVe, based on the data and information furnished by an engineer registered J.n the State of Alaska, the water supply and wastewater disposal system is safe and fur!c~, tional fo~ the number of bedrcc~ns and type of structure indicated~ ( DHEP SEAL) 7. Mail the HAA to the following add~,ess: KB2/d5/s [Page 2 of 2] 2-.15~84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH A~JTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification ~ ! If A, B, or Cr D.EoC. Approved(Y/N) ~-- Well Log P~esen~Y~N) Date C~t~leted ~'-?~- ~7 Yield~b~ Total Depth ~--~/ ! '~- ~'' Cased to ___~--~ /2 ~ Depth of G~outing. Static Water Level ~_~' Pump Set At .-~'~ z Casing Height Above Ground 3~ * Sanitary Seal on Casing ~N) Electrical Wiring in Conduit ~/N) Depression Around Wellhead (_Y~_ ~ Separation Distances f~c~a Well: To Septic/~%~in~ Tank on Lot /L3 ~ On Adjoining Lots ./.~ To Nearest Edge of Absorption Field n Lot /~ / ; On Adjoining Lots /O~3 To Nearest Pub].ic se~2ne /~'/~ To Nea~est Public sewer Cleanout/Manhole //$ To Nearest Sewer Service Line on Lot Water Sample Collected By ~--~f ~z.~7/~ ~ ~ate f? / Water Sample Test P~su!ts ~-~/'~ '~ 3"/~.~¢- 'F~P/~ ~'q , .~.. ' B. SEPT~C~/m~ TANK DATA ~3'k'~t~5]/~ O~c' //v~ ~./o/.~/. Pumping/Maintenance Contract on File (.y,~N)/v/~ ; for i Holding Tank High-Water Ala~n (Y/N) /%/~°~mporarY Holdin~ Tank Permit (Y/N) Separation Distances f~om Septic/~ Tank: To Water-Supply Well To P~operty Line To Water Main/Service Line / TO Building Foundation__~ /_~_- TO Disposal Field _~ gO/ T Pond, Lake, or Major D~ainage Co~nents [Page 1 of 2] 2~15-84 C. ABSORPTION FIELD DATA Soils t~ating in Absorption Strata Date Installed ~-- /~' ~q Width of Field .~_: [t Square Feet of Absorption A~ea Depression over Field (~ Results of Last Adequacy Test / '2-~-~//~--Type of System Design'~77~-7~L~ Length of Field Depth of Field // · 3 Gravel Bed Thickness ~>~7~ ~ . Standpipes P~esent Date of Last Ad~=quacy Test Separation Distance from Absorption Field: / TO Water-Supply Well / 90 /' To P~operty Line To Building Foundation Lot /~/~.~ ~'~ ~ TO Existing or Abandoned System cn ; O~. ~djoining Lots 3L-~ ~q~'~ , To Water Main/Service Line /v//~ To Cutbank(if present) To~_~m---~/Pond/Lake/or Major Drainage Course ~c~ To D~iveway, Parking Area, or Vehicle Storage Area ~2> f C o~¥e n t s D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) C o~m~ n t s Dimensions Manhole/Access (Y/N) ' Lavel at Vent (Y/N) du~ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA l%equest I certify tha~r-5~ve checked, verified, o~ conformsd to all MOA HAA Guidelines in effect on the data'of)/... >~:-' :/~///t~%~ inspe~c%ion. /I ~ -' '"./ ' / /(~_ /r~,. Compa/J '~ ~ ~. ~ ~-',i~iN~.~81N~ MOA NO. ';"~") EBII~/S ,' ~.~. ~,::.i., .:.~,f..,F~/,.~ ...... ', ~"~ ',~ .%".. , 9: · [Page 2 of 21 "',}.,'."' '~'"~..',- ' 2-15-84 AS-BUILT I ficrcby cb~ify that L have surveyed the desbribcd ,Anchorage! Recordin)~' Precinct, Alaska: and tha~ lying adjacent lho~to, that no improvemonts on prop- I. -.'' d that' there are no ~oadwaya, ~a~miss{on roms or, other vis hie easements on sala prope 'ty except as indicat~ hereon, Dated at Eagle lurer, Al~tm ' MUNICIPALITY OF ANCHORAGE ' '  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 · - ', ~ / ~ ENVIRONMENTAL ENGINEERING DIVISION ~: ~ Telephone 264-4720 . : , . 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, PROPERTYOWNER t PHONE Dona~L/Loma L LittleI 694-3433 MAI LING ADDRESS Star Route 2 Box 9356 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3, LENDING INSTITUTION I PHONE Alaska Mutual Savings BankI 694-9571 MAILING ADDRESS Post Office Box 1068 Eaqle Riverr 99577 4, REAL/OR/AGENT I PHONE I MAI LING AD DR ESS $. I. EG~L DESCRIPTION Lot 15 Block 1 Mountain Valley Estates Subdivision STREET LOCATION Birdsong Drive 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five .E~ Three [] Six Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) 8, SEWAGE DISPOSAL SYSTEM XJ~ INDIVIDUAL/ON-SITE'* [] PUBLIC UTIL TY **If individual/on-site, give installation date If system is over two (2) cears old an adeouacy test ~s required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS April 26, 1978 TIME TIME TIME DATE DATE DATE NSPECTOR ,~ INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [~//TH R E E [] FIVE ~ OTHER ~ MULTIPLE FAMILY ~ TWO ~ FOUR ~ SIX )ERMIT NUMBER 2. WATER SUPPLY ~ INDIVIDUAL DEPTH OF WELL ~ COMMUNITY DATE DRILLED ~ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~DIVI DUAL/ON -SITE DATE INSTALLED ~PUBLIC UTILITY Connection Verified INSTALLER ~ptic Tank or ~Hoiding Tank Size: ~ ~ 00 If Tank is homemade SOiL~AA~I'NG give dimensions: 4, DISTANCES Septic/Holding Tank Absorption Area ]Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line ~ A~OVfiD FOB _~ CEDBOOMS ~ CO~ITIO~Ak A~BOVAk {letter must accompan~ certificate) DATE B~Ie) LEGAL DESCRIPTION 72-010 (Rev. 3/78) ,,UNICIPALITY OF ANCItORAGE 825 L Street,- Ancherace, Alaska" 99501 ' 264-4720 Approval of Indi~.'.dua . Sewer ~n Waker Facil~tkeJs Property Owner: Donald L. and Loma L. Little Mailing Address: SR2, Box 9356, Eagle River, Alaska 99577Phone: 6~_7}_4_3~3~ ...... 2. Name of Buyer: n/a Mailing Address: Phone: Alaska Mutual Savings Bank Lending Institution: P. O. Box 1068, EAgle River, Alaska Mail_lng Address: 4. Realtor/Agent: n/a 9957~hone: 694-9571 Mailing Address: Legal Description: Street Location: Lot 15, Block 1, Mt. Valley Estates Pholle: NHN Birdsong Drive, Eagle River, Alaska 99577 Single Family Residence: (X) Number of Bedrooms: 3 Multiple Family Residence: ( ) Number of Bedrooms: o Water Supply: * IndJ_vidual Well (X) Public/ConmmnJty Syshem If Individual Well, well depth 59 feet If Community System, name of system ( ) Sewage Disposal System: *~On-sihe System ~) Public System ( ) If On-site System, dahe of installation: 6/77 MUNICIPALITy OF ANCHORAGe. *NOTE: A well log is required on ALL wells drilled ~q~Z~ QF/I~E~L. TH . , . . E~{At PRaT ** If on-site sewer system J.s over two(2) years old, an test is required by hhis department. JP[{ 0 A fee of $25.00 must accompany each request before~p~o;~sinq can be inih.'[aked. RECEIVED 3/?7