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HomeMy WebLinkAboutMITCHELL-STEPHANS LT 2B Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 30, 1993 Jerry J. & Carole Enders 3605 Arctic #307 Anchorage, Alaska 99503 Subject: Lot 2B Mitchell-Stephens Subdivision Permit ~SW920251, PID ~015-051-86, PID # The subject permit, issued August 28, 1992 by this office for a single family well and/or on-site wastewater system, has expired as of August 28, 1993. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewate~ and well permit. If you have any questions, please call this office at 343-4744. {J~hn Smi.-~, p_.__'RV ~rogram ~anager On-site Services enc: Copy of Permit cc: Steve Henslee, P.E. PAGE 1 OF 1 ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920251 DESIGN ENGINEER:SKLH CONSULTANTS OWNER NAME:ENDERS JERRY J & CAROLE OWNER ADDRESS:3605 ARCTIC #307 ANCHORAGE, ALASKA 99503 DATE ISSUED: 8/28/92 EXPIRATION DATE: 8/28/93 PARCEL ID:01505186 LEGAL DESCRIPTION: MITCHELL-STEPHANS LT 2B LOT SIZE: 55365 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15~55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ~--~ 1. ELEVATION OF LATERAL IN NEW TRENCH MUST MATCH ORIGINAL TRENCH ELEVATION. 2. DO NOT DISTURB EXISTING 4" RISER PIPE AT NORTH END OF EXISTING TRENCH. 3. NEW TRENCH WILL CONTAIN A CLEANOUT AT EACH END AND A PERFORATED_MONITORING TUBE WHICH ENDS AT THE BOTTOM ISSUED BY: ~ ~ DATE: SKLW Consu!t ar~t s 0 i"!-"S i 'T' E S E W!E R / W E L L P E i~ M I T ~-] p ia L, i C P~ T ! 0 N c'es~,ive ~:;iop.'::,~s~ arid d¥"air~aUe ma'~;te~,r"ns wi'bi'i;i.r~ :i.~Z~Z~ ft of the sys'bem ar:d pv, c, babie im!:)ac.t'.-:: 'bo n~.:,:i.!::il':bo:.'.:i.v'q;i pr, c,p~?:-',t [~r~c.~a'te~,- s!c,p~, appr'c, ximately z~.~Z~ to ~',:~ 'Fe~c-)'b *r~,:z,'~.~'~;in;,~(~::-:st c,f the~ sh~ss:.t u.~hei.'e 'bhey become 'Fr'c,r~'l B to ].;~.: pie¥',~e¥'rl; (~s'b:ima'bed) i-lear· the appear'~ t,::;, have no :i. ml:)a{:~t to, r~ei!;~i"lbc,~":i, rq~ pr'C,l~.:?~"'t:i.e~:, as it r'e:.iate~s to, · [" tvb ~..{pe~ a'F~d / oi'~ {e~{ J. ~i~.: :i. l"~ ~ o¥'r-~s :i. 'b ~.~ pc,'i; a~l] ). ~ ~-~{'b ~{,? w[e ]. }. f';,~ Cn"rr'9~ :i. 'g e~ ~.g~'~:S'b e~{~i'b e?~ .... 00~- 8Z LOT Undeveloped I" -- 60' DEE ~ % ,S ITF... PLAN 1"'- C~O' LOT SKLH Consultants P'.O. Box 110261 Anchorage, AK 99511 (907) 3z+5-69z+7 2B BLK1 H ITCHE L' ~TE'?HAIxi 7-Zo -Si ?/~E I of.5 NO. Oo3-.,?Z.. %F ' SKLH Consultants N ~ P.O. Box 110261 Ar~chorage, AK 9951 "----" ' -- ~F ' ---,~ (907) 345-6947 I % LOT &,~ . ~ARD 0 ~ ~ / X ~l~~ ,o~/~c~~ / , · ~ v I~¢~' . 7~.~ ~ ~~ -'~-'~-~~: .. ~ '~ / SKLH Consultants P.O. Box 110261 Anchorage~ AK 99511 (907) 345-6947 JOB SHEET NO v~ C^LCUL^rED s¥ CHECKED BY SCALE A5 kJOT-CJ}. ,-~ D^TE '7-il DATE FoRi P RAIMAC-~ PERFORMED FOR: LEGAL DESCRIPTION: I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST .,~7.f~:,~/g~usTownship, Range, Section: Tl~,/~f~lTE~:~,~/4,/' p L/~:cr'(]'_ /',~ SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT E Depth lo Waler After Gross Net Depth t~ Ol~ Net Reading Date Time Time Water Drop o 7 - D-'~z 073C, - G" I / 40 4 a q/d' Z 'Y/~ Z / 43 3 4 '//6 / ~//~ 5 / 49 Z 4 qq" /~4" 6 7- 9-~ $1 g 4 ~/4" 1 '14" PERCOLATION RATE /, ~o (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ID FT AND ]/ FT I ~* ~ I PEaFORMED BY: ~. ffg~.f[~ ~ CEaT~FY THAT THIS TEST WAS PEaFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~- ~-~ 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST I' DATE PERFORMED: LEGAL DESCRIPTION:ZO'r'dO/~./~,T't'4,~7-,~/~,O,~.~ Township, Range. Section: t SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 19 20 m Dense~ &,-own .ho dark &rou~nj damp, 4'leon ~ ~rou¢/5 -~o /Z " ~ itZ depth ~ounded /o s~ ~D ~ W*~G~OU~DWA~ - ~ ENCOUNTERED? SITE PLAN C[OqI)e'~lF YES, AT WHAT SL DEPTH? /~ ~ Deplh to Water Ailed ~ Monitoring1 /V~E OaLe: ~'~ Reading Date Gross Net Depth te O/c Net Time Time Water Drop o :P-ZS:0~ lb/s' o 6 o I / lOZO 2 / lo2o 1o /,~ 4, 3/ 11)40 lO I ~ / I ~5o io / %(~ 4 q//~ % / I/Oo /o I ¢z EHD PERCOLATION RATE ~¢~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND ~¢' FT COMMENTS Te5'~ hole ~r reserve or-eec. PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ~ ~-'~ 72-008 (Rev. 4/85)  , "%?' MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT - PHONE [] NEW LEGAL DESCRIPTION ~ Well Absorption area Dwelling PERMIT NO. DISTANCE TO: I ~ Manufacturer ~ ~ _ . .~ _ / Material No. of compartments ~ ~ Liq. capacity in gallon~ IF HOME.DE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ w.~ ~o..~ion ~r.~ ~o~ ~i~. ~M~ ~O. ~ DISTANCE TO: [~O0 * ~0 NO. of lines / Length of ~:ne Total ,ong¢o~nes Trench w.~ '~i~s ~ ~ Topo~ Material beneath tile v~abgo~ ken,th Width ~eoth Pfi~MIT ~0. ~ ~ Tgpe of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ~ ~ D~~ Driller Distance to lot line PERMITNO. ~ ~ DISTANCE TO: Building foundation ~ Sewer line Septic tank Absorption a~(~ OTHER PIPE MATERIALS SOIL TEST RATING I ] ~ ~0  DATE LEGAL 72-0~3 ~ev. 3/78) i'-il]~ I C: I ~ tLI T"~ OF A~-tm]H ..... RRGE DEF',~RTMENT i.~ ~'HEbLTH BND ENVIRONMENTBL ~ BTECTION o~._, ~TREET., 8NCHORRGE.~ ~K. ~9501 ~ . ~' 264-4720 " FJ~4--S I TE ~EWER PERM I t PERHIt N0. ,, ~[~t~. :, D~tE 0f ISSUE 52~8~ CO ~"~' · ~ W~RNINO DUE T0 CHaNGINg REQUIREMENTS THIS PRINtOUt M~9 NOt BE ~N E.,RL.T :+: ~+:~:+: C0P9 0F THE 0RIGION~L PERMIT ~PPLIC~NT HILLIBM MITCHELL SR8 BO',~: 7J.- 9950~ _.44 ~84 LOCBT I OH b I RCH LEGAL Ti2N R2W S. l~, PbRCEL 4 LOT _IZE 28088 SQUbRE FEET T'WPE OF SOIL BBSORBTION S'z'STEM IS: TRENCH MBNIMUM NUblBER OF BEDROOMS 3:- SOIL RbTING (SD FT,-BR.- THE REQUIRED SIZE OF THE SOIL flBSORPTION S'~'BTEM IS: DEF TH= IJ .... kE~ JTH-- >.~..~ J~:~ ~ E~ ....... THE LENGTH DIMENSION IS THE LENOTH <~ FEE~) OF THE TRENCH OR DRblNF!ELD. THE DEPTH Of ~ TRENCH OR PIT IS THE DIST~NCE bETWEEN THE S~JRFfiCE Of THE GROUND 8ND THE BOTTOM Of THE ENCbVbTION (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRbVEL DEPTH IS THE MINIMUH DEPTH OF GR8VEL BETHEEN THE OUTFbLL PIPE 8ND THE BOTTOM OF THE E:~C8VbTION (IN FEET). RE~T4U I RED SEPT I i~ tflN~('S. I ZE= t888 GflkkIDNS l~40 (: F' ) I ~SPEIDl I C~S fire RE~;4~J I RED B8CKflLLING Of 8NY S'~TEM WITHOUT FIN8L INSPECTION 8ND 8PPROV~L 8'~' THIS DEPbRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTflNCE bETWEEN 8 WELL ~ND AN'~ ON-SITE SEWAGE DISPOS~L S'~'STEM IS i88 FEET FOR ~ PRIVbTE WELL.~ OR i58 TO 288 FEET FOR 8 PUBLIC WELL DEPENDING UPON THE TgPE OF PUBLIC HELL. MINIMUH DISTANCE FROM 8 PRIVATE WELL TO 8 PRIVbTE SEWER LINE IS 25 FEET 8ND TO ~ COMMUNIT9 SEWER LINE IS 75 FEET. OTHER REQUIREMENTS H~'z' 8PPLY - SF'ECIFICbTIONS 8ND CONSTRUCTION DIbGR~MS 8RE 8',.,'8ILbBLE TO INSURE PROPER INSTbLLbTION PER,'1 I I E:~:P I RES B, ECEF1BER 3l.- 1~88 I CERTIF'~ THAT l: I 8M F8MILIbR HITH THE RED IREMENT~ FOR ON-SITE z, EHER_. 8ND WELLS 8S SET FORTH B~' THE MUNICIPbLITY OF 8NCHORbGE. 2: I WILL INST8LL THE S~'STEM IN 8CCORDbNCE WITH THE CODES. ~: I UNDERSTAND THflT THE ON-SITE SEWER SYSTEM MbY REQ[JIRE ENLARGEMENT If THE ~ESIDENCE ISz_P~MODELED TO INCLUDE MORE THbN 2: BEDROOMS. ........................ aPPLIOaN ,IILLI t,1 MITCHELL // / , HELL INSP 0 HELL LOG DbTE 0 DRILLER LOT 2A LOT 2B AS-BUILT RECERTIFICATION LOT 2A & 2B JiIITCHELL-$TEPHAN$ 8UBDIVI$1OI~ .P*t, el~&red by CORWIN & ASSOCIATE8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'J SOILS LOG- PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~4//~ ,' ,' ,~,/'.~ DATE PERFORMED: 1 2 3 4 5 6 7' 9 11 12 14- 15- 17' 18- LEGAL DESCRIPTION: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT COMMENTS PERFORMED BY: 72-O08 (7/76) • 6G B, •_ •-� Municipality of Anchorage ` - On-Site Water and Wastewater Program = (907) 343-7904 SA j ETY Certificate of On-Site Systems Approval Parcel I.D. (9i S'�cni —56 Expiration Date: //—/ti—/S? 1. GENERAL INFORMATION 7 _ Complete legal description ,M t C((F 7 7t N C-0‘‘ '7b Location (site address) 50 .1+ 0--f Current Property owner(s) !� � VI - �-- Day one �'�✓ T Mailing address �� /?-r17-ZC-i 5 x';i1-' ' 500(< 1111-.it/ Day Estate Agent phone 2. TYPE OF DWELLING: [NS Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual R] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: n, J(Ay Distance: Received by: ew /; _ „•&.,.._ Date: 0* COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ `JZ(o I Waiver Fee $ Date of Payment I tO L I'' Date of Payment Receipt Number 657L1 LI e Receipt Number COSA# dtG1111 3a0 Waiver# 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, 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, andregulationsin effect at the time of installation. Name of Firm Cif " l EN(5~ ?'yit4-' Phone (yr. . ` �.�• Address c.�ivt 2- r> ` Engineer's Printed Name � f"U�7 Rl •--- Date OF AL '4Ck 6. DSD SIGNATURE Ac` p4 16 ::: Approved for 3 bedrooms '� Approved for bedrooms eta •REFS G BALZARI(ut i �'F•• C -1 8 4 • Disapproved ►�c�slx.•. ` 4 •��v� � .�F�pROEESSiO\k' .fid Conditional approval for bedrooms, with the following sti tik ^+ . ,�. - ON_ SITEWATE2y c wAST E�ANp C. ATE{ PROGRAM• �c 1, ors Original Certificate Date: �--�t&-t. The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist � Legal Description: r C P /j7).13Parcel ID:O15 o5/ 5'44 A. WELL DATA Well type P PawA rC If A, B, or C provide PWSID# Well Log (YAP/ (9 Date completed vN'( Sanitary seal 0/N)/ Wires properly protected(.SIN)'/ 9 Total depth l/'" ft. Cased to 1404 ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTIONC �N10/,?-5/Date of test r ` j 7 K Static water level v� ft. ft. Well production g.p.m. "ts� g.p.m. WATER SAMPLE RESULTS: Coliform N EG colonies/100 mL Nitrate it 1C mg/L Arsenic AO ug/L Date of sample: "MAWS Collected by: C4I,4-gtES faY B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5 E r.lC/' ^.�i�ere Date installed 4/ t Y� 1 Tank size 1(0C gal. Number of Compartments t Cleanouts 6)N) YDS Foundation cleanout( N)5 Depression over tank(Y/6) R/t) High water alarm (Ye5) 0 Date of pumping 7/011)/146 Pumper A -+ C. ABSORPTION FIELD DATA Date installed 1. �©7 Soil rating (g-p d/fe-er ft2/bdrm) _ System type 'LIZ1, Length L4 3 ft. Width ft. Gravel below pipe `T ft. Total depth (3 ft. Eff. absorption area 7�K ftz Monitoring tube Depression over field ti'° Date of adequacy test 104 W17 Results ('a ail) Pn55 For r'[ bedrooms Fluid depth in absorption field before test 0 in. Water added 6 Ce gal. New depth 0 in. Elapsed Time: I0 min. Final fluid depth C in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment(past 12 mo.) (YIN &type) ,A,V vta }lllleH/A7 If yes, give date D. LIFT STATION t Date installed Size in gallons Manhole/Access (Y/N) --- "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? "'— E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 62NW On adjacent lots +I r Absorption field on lot 'E teo On adjacent lots T/CYO Public sewer main "# SCJ— Public sewer manhole/cleanout 4 /&C) Sewer/septic service line -t �eY Holding tank 4 (dorev Animal containment areas 4-(00-' Manure/animal excrete storage areas 4 SEPTIC/HOLDING TANK ON LOT TO: Building foundation * 42 Property line -I- 5 Absorption field_- 5 Water main t t(7`,- Water service line 4 to Surface water -1-10 Wells on adjacent lots 4 coo , ABSORPTION FIELD ON LOT TO: Property line "f/Or Building foundation {la/ Water main 1-10 Water Service line f t0 Surface water "F Driveway, parking/vehicle storage 1 Curtain drain * 0"... Wells on adjacent lots -ROd.-- F. COMMENTS '*(`X EiC5E-05 50 ctrAJ i QvTR E b 4T 7svv►f o r 2,%/5?AU_ FlEi. SzEt 4 0iz ���tF 4/ ,.,ok � G. ENGINEER'S CERTIFICATION ��• • ••..n I, .ter \J I certify that I have determined through field inspections and Qom. •• review of Municipal records that the above systems are in /Lj�• ' • 9 gO conformance with MOA COSA guidelines in effect on this date. * •• . • 1 H A • * Engineer's Printed Name ( lRt L 5 ot Date1/7 ` ' • ' / 'ARLES G BALZARIN•I A/ 0O /'% . - 3854 `ke/ 0. f0 4,:. iii . � ,,,�, lk PROFESS100A4-� COSA canary sheet_2-6-15.doc ' r I � I • kr'''' ti \ 1 1 R r\ kt \tea° V.A.,� \ `Na, b v fr o ^ /'0 1` L :1 ; P 1 .z i / 1.1 I 1 • • 1 b / l i ' IN ) ' it I • r • , tt? -.T ,,,IP-A9--e of �>/i/y� ��Y�.- ..410":,—/C ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-082(1 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE / FOLLOWING DESCRIBED PROPERTY: _'� "� .P•'>of A°o® ( a '�"9' ',%'%�':S-->: �G:r.- DATE.„ \E,,... •s o k AND THAT NO ENCROACHMENTS EXIST EXCEPT AS / n A. INDICATED. IT IS THE RESPONSIBILITY OF THE ;; • cIf'111 ' 'aY 4. '-' OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: ' '•••g EASEMENTS, COVENANTS, OR RESTRICTIONS x'.4!77 > /' A� WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �'" _�'� $# DylM• M h S•wor6 a VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' �--! 4 LS-5913 3 ANY DATA HEREON BE USED FOR CONSTRUCTION iyx *t\" /• ' ��,; OF FENCE LINES, OR FOR ESTABLISHING BOUND- WN ` �/, ARY LINES. DRAWN: y°f �a:`�.` 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. GENERAL INFORMATION Complete legal description Location (site address or directions) Po"- _~ ~ LT/r~/~ ~' Pr0perty owner L)o,o Mailing address 9.F'3 o Lending agency Mailing address Agent ¢;:~'eo /~'oo~z.~ Address 3g~/ '~" Z'/) Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- 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. Phone '~'-/5-'- Date _<-/-7 / DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date .-~"- / 1- ?g "The Municipality of An'Shorage Department of Health and Human Services (D~4S) issues Health Authority Approval Certificates i~ased only upon the representations given in paragraph, ~, above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a cc~..'.;tesy to purchasers of homes and their lending institutions in order to satis~ 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~}25 (Rev, 1/91) Back MOA If21 RECEIVED Municipality of Anchorage M/W 0 8 1998 DEPARTMENT OF HEALTH & HUMAN SERVICE~" Environmental Services Division MUNICIPALITY OF ANCHOP, AGE 825 L Street, Room 502 · Anchorage, Alaska 99501 ~'~'/~f3~t~-,lg',,~:~s DJWSION Legal Description: /-¢' ~ P- ~, A, WELL DATA Well type ?~ ~'~* ~e Log present (Y/N) /k/ Total depth ~/<~-,¢o,o Sanitary seal (Y/N) Y' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 4) co / /! c~ Date of sample: 5-// B. SEPTIC/HOLDING TANK DATA Health Authority Approval Checklist Parcel I.D.: ~/,E' - ¢5"-/ - ~"' FROM WELL LOG g.p.m. If A, B, or ,C, attach ADEC letter. ADEC water system number Date completed ?r-¢ - /~c9c~ Cased to '/~ '+ ?~' ~¢9¢' H,~,~ Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION ~'/~/ /~' ~>, g.p.m. Nitrate '~, ,~ 6" ~, /',.d_ Other bacteria Collected by: FI¢//~.,~ T~c4,~ ~,~1 ~.w,,~, ~,~ Date installed ~ lq ¢'5/ Foundation cleanout (Y/N) Tanksize /¢oov~,=l Number of Compartments ~-/,~ Cleanouts (Y/N) Y' Depression (Y/N) N High water alarm (Y/N) /',//,4 Date of Pumping .5-/os"/' ~ Pumper _.~-,.c C. ABSORPTION FIELD DATA~ ~o ~c~ Date installed ~/~/~o Soilrating (g.p.d./ff orff/bdrm) .~,~ Systemtype Length ¢Y --? ' Width .~ ' Effective absorption area -.~Y¢ Date of adequacy test ~'/~-/ / ¢ ~ Fluid depth in absorption field before test (in.); /'7" Fluid depth I£ Vz (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Gravel thickness below pipe Monitoring Tube present (Y/N). Y' Results (Pass/Fail) Immediately aftero"~o/ gal. water added (in.): Absorption rate = /7'5-¢2 ¢- g.p.d. ~',~ o~j,~ If yes, give date /'// Total depth 1.:7 / __ Depression over field (Y/N) /¢ For -~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION /~/. /~. Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* "Pump on" level at* *Datum "Pump off" level at* Cycles tested SEPARATION DISTANCES v. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 50' ~' (_of _~,*_r~//,~/~o ~ ) On adjacent lots /oo ' + On adjacent lots /0~~ ~ Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Water main/service line ID SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! Surface water / ~'~ ' Curtain drain IV on Absorption field /~' Wells on adjacent lots Water main/service line / o / ~- Driveway, parking/vehicle storage area !~' '~ Wells on adjacent lots ~ ~'c~ ' + Signature ~'~~ -~- Engineer's Name Date .~"~ '~. ~ ~/7/~ ENGINEER'S CERTIFICATION ~.~;'.' ~i:'~ ~ ::~ -,,.. I certify that I have determined thru field inspections and review of Municipal records, ti~ theab'o, ve syst~ns.are in conformance with MOA HAA guidelines in effect on this date. · .. .-~,..;~;..:~ ~: ~ "~i~5:-:' :. HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~, MAY-05-1998 11:38 CT&E ESI ~ CT&E Environmental 9ervlces In=. ANCHORAGE 90?5615301 P.03/05 CT&E Ref.# CHeot Name Proj t~'t Name/# Client Sample ID Matrix Ordered By PWSlD Sample 981582005 Flat~op Technical Sty. n/a Lot 2B,Mi~chell Stephans S/D Drinking Water Client PO// Pr/nted Date/Time 05/05/98 11:27 Collected Date/Time 03/01/98 14:10 Received Date/Time 05/01/98 15:10 Technical Director: Stephen C, Ede Resut ts PaL UnJ ts Nethod Limits Date Date Init Total Coifform 0 cot/lOOmL ~16 992~B 05/01/98 ~itrete-# 2,86 0.100 mg/L EPA 300.0 10 max 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.# O~- - c5-/ .-~ 1. GENERAL INFORMATION Complete legal description Lo~ 2B; ~itc~te.~.2. Stephans Sub~Lvision Location (site address or directions) ,/Property owner· · Mailing address ;"'·Lending agency· ':. Mailing address ,~,'gent 9530 ,5irc(~ Road Address Jerr~_f E~zd¢~[s Day phone 346-3928 ,-205 E. Dimond Blvd. ~590 Anchorage, AK 99515 ' Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 If community well system, provide written confirmation from State ADEC attest- 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-~25 (Rev. 1/91) Front MOA If21 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 1~U;~4 i=agJe i~iver Loop ~oad No. Address Eagle River, Alaska 99577 Phone Date DHHS SIGNATURE (.~) ~ Approved for T-~- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage 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 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. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage JUL 2 5 DEPARTMENT OF: HEALTH & HUMAN SERVICES Environmental Services Division R E C E J V 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Leg~lDescription:L*7" ~.8 ~,r~-/-/~.c $7',~,~/~/,~.1' ParcelI.D.: OI 5'- 0'~-t A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/I~I t'~ O Date completed Total depth o, J~/~ Cased to z/¢ ' ~L Casing height (above ground) (~/N) "/~- ~r Sanitary seal FROM WELL LOG Date of test u //< Static water level Well production WATER SAMPLE RESULTS: Wires properly protected (~N) Y~" J' AT INSPECTION ,¢--, / ~ g.p.m, g.p.m. Coliform Date of sample: -/ j I (, / B.~HOLDING TANK DATA Date installed ~ /~ ~ '7' Tank size Foundation cleanout (~/~ Date 'of plumping /o / C. ABSORPTION FIELD DATA ' Date installed ,~ / ''~'~ / ¢ b'; Length ~ 3 Width Nitrate 3, ) Collected by: Other bacteria s & S ENGINEERING 17034 E_%-! Eagle River, Alaska 99577 jo0 . Depression (Y/I~ Pumper Number of Com3artments u/~ Cleanouts ~N)_ ,.,, Soil rating (g.p.d./fF or~ ~; S- Gravel thickness below p~pe System type '7-/~ ¢,~ c/v / Total depth ) 3 Effective absorption area Date of adequacy test ~ Monitoring Tube present ~N) Y~-( Depression over field (Y/~ /'' ~ Results (Pass/Fail) /o Pr ~ ~' For ~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth I ~ I/3-. (ins) Minutes later: Immediately after ~; ~ L, gal. water added (in.): Absorption rate = ¥ ~-O --/- g.p.d. Peroxide treatment (past 12 months) (Y/N) ~'' ~,¢¢- /4 ,-,~ ,-,, ,v If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) i~ .... ~* igh~ *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot .~'c~ / 4- ~- Absorption field on lot / o o / "~ Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cieanout Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation !o /.~L Property line /o 4~ Absorption field · Water main/service line / e -/- Surface water/drainage I e ~ 4-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! o k: : ' Building foundation !,3 '/- Water main/service line Surface water ' ' ~ 0 ~.:, : ' · Driveway, parking/vehicle storage area Curtain drain N ~ '"[ ¢< ,v 0 ~ ,,/ Wells on adjacent lots / o d '~- )0 )o '-/' F. ENGINEER'S CERTIFICATION ' I certify that I have determined thru field inspections and review of Municipal records~t~¢~, ~re in conformance with MOA "~ g~delinesjn effeot on this date. ~% , Eng neers Name Date HAA Fee $ ~'~"~ ¢ ~) Date of Payment Receipt Number '~D'~F 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~ MUNICIPALITY 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) Lot 2B Mitchell Stephens Subdivision - T12N R3W Section 15 ~ Location (address or directions) ' 9530 Birch Road (b) Applicant Name Kpjm Nrethamer Telephone: Home 346-3428 Business 349-3569 Applicant Address (c) Applicant is (check one): Lending Institution I[}~; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) RealEstate Company and Agent Rhodi Karella, Re/Max Realty Address 1000 East Dimond. Suite 101~ Anchorage Telephone 522-1030 (f) Mailthe HAAtothefollowing address: TYPE OF RESIDENCE Single-Family []~ Multi-Family [] Other Number of Bedrooms three (3) WATER SUPPLY Individual Well E~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~,~ Public E] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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, f unctio~a.L~nd adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the infor'~Cnation 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 ~his Department has rec~ved a recertified copy of the certification of the correct legal description. This Certificate reflects the correct legal description as per the recertification. · Engineer's Seal DH~ APPROVAL Approved for three(3) bedroomsby ~ ~-~ Date October 24, 1985 Approved ×× Disapproved Conditional 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 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 9f Anchorage is not responsible for errors or omissions !n the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMEi~.~OF HEALTH AND ENVIRONMENTAL PR(~/CTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date I GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name J'O~n At'f'~-~.~,~ Applicant Address (c) Applicant is (check one): Lending Institution'~]~ Owner/builder []; Buyer []; Other [] (explain); . (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address /Ooo L= ~::~¢,~_~ Telephone ~ ~-z_ ~O ~ 0 (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well'[~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 {1%84) Page 1 of 2 ~NGINEERING FIRM PROV D!,~.~,.INSPECTIONS, TESTS, FILE SEARCH, D~/~, AND INFORMATION < ' As certified by my seat affixed hereto and as of the validation date shown below, I verify that ~ny investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fu nctional 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 flies 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 ,.~ ~ / - G~'-© ~ (~) Address /2_00 ~' ,.~ ~-¢2' ,A-,'%c/~ ~ K ~l~/ .~2'I Date IO - ~ - ~.~ DHEP APPROVAL Approved for ~ ~) bedrooms by Approved X Disapproved Terms of Conditiorial Approval Conditional Date 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 (~ 1 841 TO ~ALASKA ENVIRONMENTAL CONTROL SERVICES, IN, C, L~, . 1200 W. 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 (907)~2Y~--1~1 '~-/~/-' -S'~ ~/~ JJOB NO. WE ARE SENDING YOU v~Attached [] Under separate cover via [] Shop drawings [] Prints [] Plans [] Copy of letter [] Change order [] the following items: [] Samples [] Specifications ALASKA ellUlROllmellTAL COI1TROL ~ ........... s ~ :: :: ~ · ===================== ~%:::: *a:::::: ~: .~, ......... ~,:~:-:, ........................... -e~ :~. ::::::::::::::::::::::: ~' :::::::::: ....... ~: ~a,! .............................. ::::::::::::::::::: :::::::::::::: ::: :::: : :::: :::~} ................ :: ::~,,: .................. ~t :~ :/~ :::::~ ..................... ~,~,~::::~: .............................. ~:' ........... ALASKA e~HdlROFlmt~FITAL COF1TROL SElq-OIC6$, IRC. [~n§ineerin§ $ I~nuironrnen~ol Studies December 11, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Gentlemen: Attached is a copy of the as-built for Mitchell Stephans Subdivision. It only shows a house on Lot 2B. The Health Authority shows Lot 2A. Please correct your records to show the correct legal description of Lot 2B. cc: Alaska Pacific Bank 1200 L[J6$I 33rJ Au¢oue, $uii¢ ~, Anchorage, Alaska 99503',(907) 561-5040 Mb~iCIPP~ITY OF .,~NCHORA. GE DiViSION OF ENViRO?SENYAL B~;2J~TH D?PA~THENT OF ~P<A/~TH AND EN(;IROIC.~ENTAL PP. OTECTiON APPLICiT!~N FOR. t~LALYH AUTHORITY APPROVAL CERTIFICATE 1. General tnfon~ation Application Date (a) Legal Description (include lot, block, subdivision, section, township; range) Location (address or directions) ' (b) ApPlicants Name ~o~l ~-~l~m,~ Telephone - Home Appltcan'ts Address ~5'30 6=~ch 60 (c) Applicant i~ (check one) Lending Institution (d)-~e~ding.Inst~tution 'Address Telephone .. (~) Telephone ~']22- / O~O Mail ~he HAA tO the following address: e Type of Residence Single-Family.S. Number of Bedrooms Multi-Family~--~ Other (describe) Water Supply~ ndivi =l Well o=un t ubl c f--q Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal 0nsite ~--~ Public ~--~ Community ~--~ Holding Tank ! t Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering · ~- ~es~. ~-;_~e Search; Data and Information tions in effect on the date of this inspection. Name of Firm /~i~_~ As certified by my seal affixed hereto and as of the validation date showa 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. ! further verify tnat~ based on the information obtained from the ~micipality of Anchorage files and ~rom my investigation and inspection, the on-site ~ter supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- Date (ENGINEER SEAL) DHEP Approval ~ _-e~-~d for_ edrooms Approved __ Disapproved Conditional Terms of Cond,i~tional Approval ~i~J[ ;~ yY-t~c~.~-~-- t~. ~-~~~ ~/~.~f- f'~- ,- ' ~ _ . ~-' ~ /~ --u~' '.'' CAUTION THE MRfNICIPALITY OF ANCHORAGE DEPARTM. ENT OF HEALTH AND EN~IRONb~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-~ ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIOnaL ENGINEER -REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES ~HIS AS A COURTESY TO Pb~CiJASERS OF HOMES ~'ID THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ,%ND STATE REQUIRE-' MENTS. ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~ALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE ML~ICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS! OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D!8 [Page 2 of 2] 7-19-84 ~' DATE RECEIVED TIME" , d INSPECTION APPOINTMENTSTiME TIME~)'/'~'~ DATE DATE DATE .MU.H!C!P,^.L!TY OF .^.klCN~II~ARP -- DEPT. OF ~;~.*,t. Ti{ & MU NICIPA LITY OF ANCHORAGEc~' V RONME~,-.'L ; L.D'~' ECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT ON  825 LStreet-Anchorage, Alaska 99501 APR 2 9 1980 ~, ENVl RONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED 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, PROPERTY RESIDENT (If different from above) PHONE ~ ~ PHONE MAILING MAI LInG ADD,riSS I 5. LEGAL DESCRIPTION ~,-.--~/,~,~ 6. TYPE OF RESIDENCE .~'~SING LE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ,,~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ~ ,-~3 ~, ) ',,-~m---- -~ f 106 I ~, /.~_ ( I , , ~, .... . ¢~ ~,~J THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ · [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTH E'R [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE¢ DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER r-18eptic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/HoLding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5. COMMENTS - , ~/~APPROVED FOR~ BEDROOMS //~ E~ CONDITIONAL APPROVAL (letteLmust accorr~,.a~y c~rt~icate) DATE/,/~ ..,.~,¢" BY I ~ ' / y , /~'o, ~'o/ r'-).-., I/ 1,1 72-010 (Rev. 6/79) July 2~ 1980 Wilfred Mitchell STJ% Box 73 Anchorage, Alaska 99507 Subject: T!2N, R3W, Section 15, Parcel 4 It has come to my attention that the well on the subject property has not been upgraded. As ! discussed with you onoour first meeting, the well casing needs to be extended 12 inches above ground level and sealed so that it is water tight. If there are any further questions, please oontact this office at 264-4720- Sinoerely, Robert C. Pratt, R.S. Associate Specialist RCP/kas Walt Stephen Polar Realty 724 E. 15tll Ave. 99501 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION June 5, 1980 Wilfred S. Mitchell Star Route A Box 73 Anchorage, Alaska 99507 Subject: T12N R3W Section 15 Barcel 4 Approval for your individual sewer and water facilities can not be granted until the following is completed: (1) The septic tank pumped with a receipt submitted to this department. (2) The water analysis report be delivered from Chem Lab, 5633 B Street, and reviewed by this department. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LNB/ljw