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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.
Form EQ-032
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I:i',FI(:t.::;F:; ;t; L.i... ;I[ I'.,ll;.;i OF I:::Jl',]"i" :!i;'.r':ili;'l'liii;t"i I,.I ;fT '1'i..101..1'1" F:' :1: I",li:ll.. Zl: H:!i;F::'li!i;E:'l" ;!; (;)l",! F::It",II;;:, "1"1' I': ;;; ','" I. lii','.r' "J'!'l ;t; '.!ii;
I;:,EF::'l::lI:;i:'t'i"iti!;t",!"t' !.,.l :t; t .. 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