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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 6 LT 8�,rliay 28 19 08:12F Anohorage Well & Pump Ser ;072430742' P.1 beVelopment Services C)epcirtmen-t 6-, Building Safety Jbivision I.$ OR!, On -Site Wates WOSteWater Program S 4700 Ehore Ronci P.O. Box 196650 Anchorage, A.V, 99507 er sore -r (93?) 343-79C.4 Pump Installation Log Well IM11ing Permit 'Nurn 1) er: Date of Issue, Parcel Identification Number: _6_17 - 391 0 Legal Description Property Owner Name & -.Address: fp OM l'o f P_�& 1) L a o�4 di wi sr Y), 1 If PtImP li,, staff "011 Date* S -2 Pump Intake Deptli Below Top of leVell CasjDp: 3 feet Pump M2nuhictunx's Name, Pump _Model. L/ Pump Size ftp, Pitless Adapter Burial Depth: feet. Pitless Adapter Mannfacturer I's Name: Pffitss Adapter Inst;L(ler; M /A Well DlsinfectLd Upol, Con,pletioll? No N"Who4o of Disinfection. 'c"'. Camwents: Puw.P .installer Name- D(y Attention: Tbeyimp il, .Sta]jer Shall provide a punic jr�s- log to tb� DSID within 30 Jpys of Llj,,.Ip MUNICIPALITY OF ANCHORAGE , ~ ' ' DE, RTMENT OF HEALTH AND HUMAN SER'~.~ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name /V/~r"n~,¢'~ ,~o ~*~ DISTANCES ~ Tn SEPTIC ABSORPTION Address F,~~ TANK FIELD WELL Lot Block Subdiwsion A ~ ~ ~ '~ ~ ~ ~M ~ ~-~-- ~ FOUNDATmDN Township. Range, Section ~e~ I~ ~1~ ~ ~ -AS-BUILT DIAGRAM (Show oca one we .sep csystem, propertyhnes, foundat,on~ TANKS ~ ~TRENCH d BED ~ W. DRAIN ~ OTHER J / FT FT onginal grade Fill added above orig,nal grade Gravel depth beneath p,pe ~ ~ FT FT .... ~/~)- ~ / t Total absorpt,on area Dist .... between ,mos SQ FT Pmpe material FI Number of ,,nos / Installer Date ,nslalled / ¢ / 7~' WELLS / ~ PRIVATE ~ OTHER(identify, /' 1¢* ' / Ciass,f,cahon (A.B.C, Total Depth FT Cased ,o / //z( ~,~ Installe, Date Installed: ~ ~/~- REMARKS: Inspeclions Pedormed ~nicipal and Slale g~i~elinss in ~lls~l~l~is Cal~: Z '~ ' ' Health Depadment Approval: ~~ fl ~~ Date: /a-~-- 72-013 (3/85) .... ' .......... 09/' 'i 4 ./]~i'?' i o'?. !... Cu::! a ;I :: Sub d i v ii. s ii. on :: MOUNTA i ixl F'AF.~K EST I c~l. '5:i x~.,:., ;:::'1. i/ilO (Hq. f i',,, or' ~'"J.:3X ](.~S{'(i l' (}i;;~iii~ ~ 'ih ii. !~:. F'~'.;~'i'" fli :i i,' 'j ;~; FO'I,', & ]. Cal:i ac: i t.':/ Engineering, Planning & Surveying 2220 E. 88th Avenue, Anchorage Alaska 99507 Telephone (g07) 344-1352, 349-6451 DAILY INSPECTION REPORT WORK IN PROGRESS THIS DATE DATE 7- CONTRACTOR WEATH ER QUANT. CONTRACTORS WORK FORCE AS OF NO. LABOR CLASSIFICATION NO. DESCRIPTION LOCATION EQUIP, DESCRIPTION DESCRIPTION OF WORK J INSPECTOR. 1 GREKCER ANCHORAC AREA BOR dGH Department3330°f EnvironmentaIc Street (~uality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM N AM E'~"~¥'~\ LOCATION MAILING ADDRESS '~"¢--~ r~O~ Z~'-~"~ PHONE LEGAL DESCRIPTION L'~'g '~' ~'~ ~. SEPTIC TANK: tu~r DISTANCE FROM WELL I.~ ANUFACTURER. MATERIAL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __ NUMBER OF COMPARTMENTS .LIQUID CAPACITY /(~(?3t~ GALLONS. SEE PAGE ~ :'~F'~'~-./~ c. H NUMBER OF PITS , DIAMETER __ G'x OR WIDTH__ LENGTH DEPTH LINING MATERIAL BUILDING FOUNDATION__ ADDITIONAL ABSORPTION CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) NEAREST LOT LINE SQ. FT. WELL: BUILDING FOUNDATION __ CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC I / LOT LINE SEWER LINE TANK. [ (~::~ SYSTEM SEEPAGE i (~ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED. REMARKS DISTANCES: INSTALLED BY.''~'~- ~J CL ~-'A ~ ~ I~ PIPE MATERIAL: LOt SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM G.A.A.B. GRE,... ER ANCHORAGE AREA BO; UGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE. ALASKA 99503 TELEPHONE 274-456 ! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. N*','E OF APPL,CANT ,. ?p,"¢ MA,'l.G ADDRESS ,NSTALLAT'ON ,.OOA'"',O. ,__"'¢ ~' SEEPAGE PIT DRAIN FIELD INSTALLATION OF: SEPTIC TANK P,N^NCED THRO.GH TO BE ,NST^LLED BY '~-~ ~-/ NOTE: THIS PE~:~MIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. OlAeRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pt~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE P~ WALL SEPTIC TANK ~ ' , SEEPAGE ~z~ ~ . DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK // DRAIN FIELD WATER MAIN tO SEPTIC TANK / ~'~'/ DRAIN PIELD SEEPAGE PET TO RIVER, LAKE, STREAM. SEEPAGE I;A~ ALSO CONSIDER AREA WELLS. SEEPAGE PIT /~ DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CR[B CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTight REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR I CERTIFY THAT IAM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE I-~ --als~°~ertify-.~l~t this home will contain a maximum of three DESCRIBED SYSTEM ACCORDANCE WITH SAID CODE. (;~)e~rooms. .Lumderstand an upRrade~oul/t~be;~e_d~ should more bedrooms be added. GREATER ANChOrage /~rEA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION ~'~~'~./4j./ /~'~..~"~Z~ .~~ /-~ ~) INSTALLATION OF: SEPTIC TANK SEEPAGE PiT . DRAIN FIELD · OTHER ., 2 FINANCED THROUGH :TO BE INSTALLED BY SOIL TEST RESULTS /-~ /~ .~~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL ~S7 COMPLETION DATE ANTICIPATED FINAL INSPECTION: Z4 HOU~ NOTIC~ ~QUI~D, ~ACKFILL[NG O~ ANY SYST~ WITHOUT ~INA~ INSPECTION ~y THE DEPARTmeNT O~ ENVIRON~NTAL QUALITY AUTHORITY WILL ~SUgJ~CT TO P~OS~CUTION. MINIMUM DISTANCE~;, REQUIREMENTS FOUNDATION TO SEPTIC TANK-- fOUNDaTION TO seepage PiT J~ SEPTIC TANK TO SeePage P~T WALL SEPTIC TANK Jf TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRA~N FIELD DRAIN FIELD ., SEEPAGE PiT DRAIN FIELD SEPTIC TANK, //~/~, SEEPAGE Pit TO RIVER, LAKE, STREAM. , DRAIN FIELD -- SEEPage Pit /~ ~ ALSO CONSIDER AREA WELLS. . SEEPAGe Pit ~ / CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SO~L. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. TYPE DIAGRAM OF SYSTEM DATE ~///~/~/~· APPLICANT'S SIGN AT UR E~' TM/e--' GRi,~/ER ANCHORAGE AREA BOROUGH d.,jbll~2 Depart~ient of EnvironmeFftal Quality ~ 3330 "C" Street /q ~aoka 99503 Anchorage, ~ ' ~ Performed. for Er. J:ames'B~ovm Date performed April 26,197,'4 -~41 Legal DescriptioF~: 2~Q$ 8 B.to~ck 6 I~ountain Park Estates # 1 S~bdivision~ This form reports: Soils log x Percolation test 'Depth Feet ' 14- /~s/' ground water encountered? If yes, at what ~epth? .... 'Reading Percolation race Date Gross Time minute. Net Time Proposed installation: Seepage Pit"~' Depth to H20 Net Drop Drain Field .Depth to Dottiom · L 'qEATER t,t~CJlO~A",J.i AI-:EA bOROUGH. ' . ~ · -:~' }tEALTii DiJPA;<T~:EHT '~'" CASt, ,. ~ ~ ' ANCtlORAG~ ALAS?~A'99501 Pepforn~cd Fop ~ ~..~r /T~_ff~.~r Date Perforaed ~ -/ ' ~..,.,~-~T~--~,,-- -: ..... ~~ .-~7~ ~ - Dcpth feet [,coat ich Sketch ! [ Was G~¢und l'la~e.~ Encoun~¢red?_.~g~.~ ~,o~ Readlng Date GPo .... ~r,:e -;t ,ime De.th To H20 Net Drcp c Fr'c~sed Irmtallat~on: Depth__Of" 1;:Zcl:_ ........... 1)(9'c;, 'fo i~o~ro~r, Of Pit O:- Trench Data CeFtificd MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 parcel I.D..# CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~::~/~- .,~ ~'/- 4:2 ~.. "4 NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) - (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Location (address or directions) Property owner X~r~-i t- :),ti4 ~_z~/f(,~lophono ~ (home:¢~-/~c~ Business Mailing Address ,~ ~: / / ~-[~[~ .~ ~, (c) Lending Institution (d) Mailing Address Real Estate Company and Agent Address '~ (.~00 (~..,m~ Telephone (e) Mail the HAA to the following address: (or check here i-1. if hold for pick up.) List contact person and day phone number below: ~-: 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Wel~,, Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status: 4. SEWAGE DISPOSAL On-site~L 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 (Rev. 7/88) Page 1 of 2 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, 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. NameofFirm ~D/t-)5~'. ~'AJ~//d,..~' Telephone r~C/z'~ -ZOO0/ ~,.79--~'~c'p Date 6. DHHS APPROVAL ,&,pproved fo',;. Terms of Conditiona! Approval bedrooms by ~-~~ ~ Disapproved . Conditional Date ~-~'- ¢2z~ The MunicipaLity of Anchorage Department of Health and Human Services(DHHS) issuesHealthAuthorityApproval cerificated 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. 72-025 (Rev. 7/88) Back Page 2 of 2 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number t',) Date completed'7~°~ T~ I--'-+~, Driller ~'~ Total depth ~"+ 5' Sanitary seal (Y/N) Cased to '7_."+~ / ',/ Wires properly protected (Y/N) FROM WELL LOG × AT INSPECTION g.p.m. // Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main -F v.a o' Sewer service line ; On adjacent lots -~ ,co'RECEIVED ; On adjacent 10ts +~oo' Public sewer manhole/cleanout Petroleum tank -~oo' WATER SAMPLE RESULTS: Coliform Date.of sample: Z_/~_ ~x_-/ Nitrate Other bacteria Collected by: /'/, ~--~. B. SEPTIC/HOLDING TANK DATA /'~-/,~., ~/./ Date installed q-$o-3~ Tank size Cleanouts (Y/N) "/ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping I ooo ~-~ Compartments ~- h.) Depression (Y/N) N) Alarm tested (Y/N) '~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage I00' On adjacent 10ts Absorption field '~- ~ -t- I00 1 Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANC~-5~D~LIFT STATION TO: WeI~3R'~[~-~ On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Z~.~' Total absorption area Date of adequacy test Manhole/Access (Y/N) .CyeleC~'st ed Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) - ~ Soil rating (GPD/Ft2) ~ ~-'~ Width ~ ' Gravel thickness '~7.~ ¢'~ Cleanout present (Y/N) %- ~ 7.-~ 4 Results (pass/fail) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 4- IcaO' On adjacent lots Surface water Depression over field (Y/N) for After test If yes, give date System type Total depth Bedrooms Property line ).3 ' To building foundation On adjacent lots Su trace water + I ~©' Curtain drain '~ ~' To existing or abandoned system on lot Cutbank Jqoo' Water main/service line Driveway, parking/vehicle storage area + 3 E. ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t?~,.~f,..this inspection. Signature //"~4//~ ~ ~''''-'' f ~ ~'~'~ '"''~ ~'~ Engine,s Name Date ~ - / 7 ~ HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee ¢~< Date of Payment Receipt Number 3- :3; HAR ?i '94 ~Z:OgPH NTL ANCHORAGE P.i NORTHERN TESTING LABORATORIES, iNC,' ~A~R~ANK~, ALASKA ~?01 (907~ 4E,~-3i i6, ~AX AN(~HO~AG~, ALASKA 99503 [907i 277-8378 · ~AX DRINKING WATER ~NAL~SL5 ~tEPORT FOR TOTAL COLIFORM BACTERIA 9601 Buddy N¢:me~~ Anchorage, An 99516 Pub!in Wate~ Sy~t~ I.D.S Date Rec~iv@d: ua=e Analyzed: Date R~po~ted: N~ Sa~p!e Dust 03/14/9~ Tim~ R~¢eived~ !6~30 03/14/94 Time Analyzed= !6:30 03/17/94 Time Reported: 09:43 ~O~%m~nt S: U POS HSM gA NT = " ~ gati~factory Unsatisfau%ory None De~ect ed Too Numerous To Cottt'~% ( ~2(.)t.q Coioni~) Conf !umnt GrOwth ~m~nt ' "~" " - Not Be R~liabl. e Anaiy~],s Resamp!e Requ t red * # Colonies/lO0 ml ~Sa;ap.~ ~ Total* F~ca!* Other* LocatiOn l,~e TAme ~-~=u~ ~;ul~zurm coliform Bacteria M~a~ ~ih r,~a ~w ~J3/12/94 ~6~3t) AAi34i9 "~ ND NT HAR ,~ "~4 O~:O~PH HTL AHCHORA~E P. p T ~ NORTHERN ,EbTING LABORATORIES, iNC,- cA RBANK-S. ALASKA 9970~ ,., ,.~,~_R~G_ ~, m,._ASI(A 99-¢93 456.3; 16" FAX 4~(5-31~5 ~77-8378" FAX ~74.9045 Constr~¢ting En~in~grs 9601 Buddy Wern~r Dr. Anchorage A/< 99G~6 Attn: ~ Date Arrived: Dat~ Sampled: Time Sampled: Co!l~ted By= 03/15194 03/~2/94 !~30 Our ~ab #: Loca_ti~n/pr,' Lab Nuraber _¢.i29¥66 * Defini%ion~ B = Below Regulatory Min. H = ~bove ~egulato~y E ~ ~stima%ed Value M = Matrix D = Lomt to Dilutj MDg ~ Method De~ec::~ ;u Limi~ Date Da~:e ?r a, pared Analyzed ?,ei:>ort~ed By: An,r. he~y""J'~ Lange ChemiStry Supervi~o~ Tom Fink, Mayor uni ipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 31, 1994 Henry H. Wilson, P.E. Constructing Engineers 9601 Buddy Werner Drive Anchorage, Alaska 99516 Subject: Waiver Request for Lot 8 Block 6 Mountain Park Estates S/D Waiver Request #WR940012, PID #017-391-03, HA940149 Dear Mr. Wilson: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: the private well to the septic tank of 96 feet. r.~ MUNICIPALITY OF ANCHORA~0. Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR940012 PID# 017-391-03 Date Received: March 22, 1994 HA# HA940149 Permit # Legal Description: Lot 8 Block 6 Mountain Park Estates Subdivision Engineer: Henry H. Wilson, P.E., Constructinq ENgineerS 9601 Buddy Werner Drive, Anchoraqe. Alaska 99§16 Applicant: Norm and Sandy Johnson Waiver Requested: Well to septic tank of 96 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation w/)/vE~ R¢4~uE~r ~A/W~I~ wRcptO012 WI~IV£R f~E~I4EFT ?~R ~tV-JdT W£LZ ?~ SEPT-/~ T,~IvA' Df' ¢ff F£,e~ rY. 8 1.8 I / ~ / ' 12921 J/ 21 ,/' / 12455. 20 12947/ I ! I 58:51 HOLDEN 5800 5850 I0 9 5821 KAL( 5941 /9 / DR 15040 5900 5 4 8 5841 18 13021 ./ 15120 5861 7 17 15037 8 13047 14 421 6061 15100 /$ 13110 4B.~.5 ~_.8018 12901 / 2 Ld 12915 .~A 12931 13001 4A 5 13101 15115 8 13131 9 12821 MOUNTAIN 5 2 5 232 March 15, 1994 Municipality of Anchorage DHHS, On-Site Services Section PO Box 196650 Anchorage, AK, 99519 Attn: John Smith, PE On-site Services manager re: Waiver request for Well-to-tank Lot 8 Block 6 Mountain Park Estates Sub #1 Dear Mr. Smith: As result of performing an adequacy test of the subject lot we are requesting a well-to-septic tank separation distance waiver from the minimum standard of 100' to 96' The tank was replaced in Sept 1987, and apparently the inspector did not measure accurately the horizontal separation distance between these items. Attached to this request is a current survey of the lot, showing the distance to be measured at 98.6' between the well casing and the cleanout. We offer the following calculations to substantiate this request for a waiver: SEPARATION DISTANCE WAIVER COMPUTATIONS (per 1-3-85 Guideline Memo, Bruce Erickson, State DEC) 1. Static level in well 241' Septic field elevation: 10' below grade and 10' lower than well at sump Bottom of Septic to H20 Table 220' POINT VALUE 7.6 2. Soil Sorbtion: Date in MOA Files and experience in this subdivision indicates sandy silts POINT VALUE 3. Permeability: Silt = 2.0 POINT VALUE 4. Water&Gradient: Fine Sand = 1.5 3.0 1.8 POINT VALUE 5. Horizontal Separation, Well to Septic Tank = 96' POINT VALUE 1.2 2.8 TOTAL POINTS 16.4 According to the Guideline, number values > 16 are almost sure to be free from any form of contamination from household sewage. Respectfully, Henry H. Wilson, PE Attachment as stated Lo:d: :://< A5 BUI L 7- ; /%~': /O, ~ ~:. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. O,.: I~2ALTH & e DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~NViRONMENTAL ?ik'~FECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION OEO 1 1~ 1978 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE ~ MAILING ADDRESS PROPERTY R~S~DENT (~ ~ff~F~n~ ffo~ BDOv~) ~ ~ PHONE 2. BUYER MAILING ADDRESS 3. LENDINGINSTITUTmON ) PHONE MAILING ADDRESS MAILING ADDRESS 5. LEGAL DESCRIPTION ~ STREET LOCATION ~ ('(~'- T- ~ ,~ ~ TYPE OF RESIDENCE · ,~ SINGLE FAMILY Eli ' MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **if individual/on-site, give installation date I~-'~ If system is over two {2) years old an adequacy test is 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 TIME TIME TIME DATE DATE DATE I NSP ECTOR I NSP ECTOR INSPECTOR DIRECTIONS; NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY MULTIPLE FAMILY [] ONE [] THREE ~] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~J IN DI VIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified [~SepticTank or [] HoMing Tank Size: _,)_('~O If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED F;ERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURE~ MATERIAL - Septic/Holding 'rank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS DATE I LEGAL DESCRIPTION 72-010 (Rev. 3/78) [] APPROVED FOR BEDROOMS [~ CONDITIONAL APPROVAL (letter must accompany certificate) ~J~-~'DISAPPROVED BY ri'ii!e) December 18, 1978 Graham Young t.~rston Real Estates 2804 West Northern Lights Boulevard Anchorage, Alaska ~ ~ Subject: Lot 8 B~ock 6 Mountain Park ~states Subdivision Mr. an~ W. StarrY Approval for your individual sewer and water facilities will not be gr~nted until the following items have been completed: ~ ( ) A well log is submitted to this department. ( ) The top of the well casing is sealed with a sanitary seal so that it is water tight. ( ) The depression or pit around the well casing should be filled with ~pervious type soil so that it slopes away from the well ca~ing. ( ) The welt casing is extended twelve(12) inches above ground level. ( ) Expose the well for our inspection to determine proper construction, also, to insure the minimum distance requirements are m~t between your well and sewer syste/~. (X) The septic tank is pumped with a receipt submitted to this office. ( ) A four (4)'inch ~ast iron ~leanout be installed to the septic tank or leaching area. ( ) A percolation test be [~rformed on the existing leaching area. This will determine if the system is adequate according to National Standards. A list of private firms who perform the test is enclosed. ~rana~,zoun9 De6ember 18, 1~7'8 Page Two () Your application shows the n~ber of bedrooms exceeds the number the sewer system was originally approved for, therefore, an upgrade will be required. ( ) Connect to the ~ablic sewer whioh is available to you. Notify this department for a re-inspection when descrepancies have been corrected° If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt~ Associate Specialist RC /tjw ccL State of Alaska Veteran's Administration 907 West Northern Lights Boulevard 99503 GREATER ANCHORAGE AREA B?~_G~H~. ~F Department of Environmental Quality 2330 "c" Street, Anchorage, AlaSka 99502 274-4561 Date Received January 13, 19 6 Time of Inspection Date of Inspection~~ l. Approval requested by: Alaska-National Bank Mailing Address: Pouch 7-010, 99510 2. Property Owner: James & Josi Brown Mailing Address: Star Route A Box 1566-P 4. 5. 6. Phone: 277-5511 x 31 Phone: 344-1329 99507 Legal Description: Lot 8 Block 6 Mountain Park Estates Location: NHN Ridgeview off of Bird Road Type of facility to be inspected Single Family No. of bedrooms 2 Well Data: ~ In~tiv~ua t A. Type . _ _ B. Depth 273' C. Construc~on D. Bacterial Analysis Sewage Disposal/S/~tem: On-s'te system. A. Installed 1/76 B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank/~)~ , Absorption area Nearest lot line /~)'~ , Other contamination B. Foundation to septic tank 2. Manufacturer 2. Material --"~/~.3~f , Sewer lines __~, ~ . Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages · 'Page 2 of two pages - Re~ st for Approval 'of Individual [ 'ar & Water Facilities . -legal Description Lot 8 Block 6 Mountain Park Estates Comments Approve~_/~_~_/~__Disapproved Date Approved for one year from date signed Greater Anchorage~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM i certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) Januar~ 137 ~976 1. Type of Inspection: 2. Property Owner: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 -- 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPARTM'~NT OF HEALTH & I::NViF<ONME NTAL PROTECTION JAN ! 976 RECEIVED CMRO James & Josi Brown VA FHA CONV ~ Mailing Address: SRA Box 1566-P, Anch. Ak. 99507 3. Name of Buyer: Wilhelm M. & Margaret Starck Day Phone 344-1320 Mailing Address: 705 Muldoon Rd. #46, Anch. Ak. 4. Name of Lending Institution: Alaska National Bank Mailing Address: Pouch 7-010, Anch. Ak. 99510 5. Name of Realtor or Agent: N/A Mailing Address: Day Phone 337-7338 Phone 277-5511 ext.31 Phone 6. Legal Description: Lot 8~ Block 6, Mt. Park Estates Location: NHN Ridgeview up Huffman, off Birch Rd, 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Single family Public Utility No. Bdrms. 2 Individual If Individual, number of dwellings presently served If Individual, depth of well 273 ft, Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 1/76 EQ-037 (1/74)