HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 3 LT 6
i ' 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
NAME IPHONE [~NEW
MA,L,NGADDRESS 7
DISTANCE TO: Well Absorption 8rea Dwelling
~ Z Manufacturer Material No. of compartments
~ ~ DISTANCE TO: Well ~ ~ Dwelling P~RMITNO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
~ ~ = No. of lines Length of each line Total length of ,ine~ / Trench width,, Distance betwee, lines
~ Topoft,letofinish~rade ~ ~ ,, Mater,albenoathtila ~ ~ 0 [I inches Totaleffect,vea~m~rea
~en~th : ~idth Depth P~BMIT ~0.
~ ~ Tgpo of crib C ' lam ter Crib depth Total offective absorption area
m . Building foundation Nearest lot line
~ DISTANCE TO:
~ ~,,ss ~ Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER ~ ~ ~ ~-~-~
SOIL TEST RATING ~OO 3 g ~ ~
REMARKS
VED DATE LEGAL
72-013 (Rev. 3/7~)~
F'IERH];T HO. ( 78Ei26i:::
f"'il::!::'~: il i'"iUi'1 ! ~l..1I ~::, ;,,. IiIF Edi!:li:6:Euiff'1:~; ~ '!: ('. ]: L :;'I:::iT
~r',n,~' ............... F;;:Z(;:!I..li(I:;i:E!:, ':::'i'::::'I:::' '"~F' THE SO:IL. !:::!.r::~r'_:ii;QFN:"i" i OI",i ':".:.,~":'T':"'~ .... ]::i5 '
-'-" .......... ~ .... ~:~ ............ i'"""
F" ,, ~:x:" ~::::~ "7,.- ~..-,-I =::::::: "::" t, ,~..-. ~ ....~1 il -, , p.-.,l :: ,...:::. F.' -i~ ~:;;;ii~ ?'1i ~"~""
'""~ '~ ....... t f'",~:. !t".h.~ ,! ...! '! r"d:;?
~,...h::. LIENI!i'T'H [i:,:IiI','iE.:.i'.~'.~:'i'-'I'-,i ~'..., THE L.E:]',ff:N"H rT?, F:!EET';, fW:: .... '- ......... '"" "-I?F:'rhn::'"P' '",
THI::: ................. r':,F:!:::'TH OF ~':::', 'i"F'.EN, E:H 0I:;?. ..... P:!:T T':::; THE P,i?T'F:iHCE iNE'T'HEE~iN THIE '.51...I[:;i'.I:::1::1t2!~.-i iili::: '~"'~ r"!!".:. ......
.............. ![. I:::i?',!E:' i"HIi:' ............ 8EFI"T'Oi"i OF ,'" r': ~:.,:':,L:H","H i l/~'" i''I ( T H - ~.r: ......... ~. ::,.
'T'HE:RiiL' :('::-/'- !",I0 '!:E"T N'[["-t"H i::;'i'"II:;;' 'Ti:;i:EN(3HIE'.!i;.
," r", ..... , ...... -¢: ::, . i::1 I:: i::'""i Ii::' :::'?-, THE IiII.J"i"I:;;'i:::iI....L I'"' .!. i'"'i:.
THE ":~:;:,~::','~::'1 ~..'c. !H ~":: THE H]iN]iHIJH -"DIiPiP"I'H Ur" ·
!::!NJ) '.Ft...II::' ................................ ::: '" 'l"T "' !',i f"!F' 'i"-II::' : .......... ,:"~.~ ..................... u:: n- ~' r' l'. ~' T '.,I r::'~::l::'T "~
,~ ,-.~ tk.... ~ ........ ii t' I?.: ~':~1 ~1::::'.E:i;; El}il ~:~::" "%" lie ~..J: -'?- ¢::::I~ P"',,~ P<::: :I~!~;; 11 ;2!:: ~}!E: ......... ""::::;; il.i-':::i; iLzii ii'm'i I I C3 ..... ' ......
i CER'/" Z F'"? THFIT
:~_: :J: I::!i'"I I::FtPtl;L.',(I:::!t:;-:.' t4:~TH THE F:EE!IJ];F:EI"IENTS F'OF: O1"4"'":5:i1'i'!! SE!.'.!ERS Fff',lE:' I,.IEiL. L.S I::tS SET
FEI?.TH E?'? THE: HLIi",!:[ C :[ F'FiI... i 'T'"? OF Fii",ICFIE',F.!t:::!GE.
2: ): b.! Z L.L :[ NSTFILL THE S'¢STEH 1 !"4 FICCEU:;;:[)!:::!i",ICE !.'.! t TH THE CODES.
3: Z I...I!',!D[ERSTF!Ni?' THFIT THE ON-'S]:TE': E;E!.'.tEI:;;: S'.r'STr:i~:H 1"!Fi'-¢ I;%r.E(;:!i..~}:F;:!E [.~:HL..F:ii:;;:(:~iEHENT
F:ES :[ [:,!Ei'.,ICE ]; S F.:P::.H l DELED TO
F1PF'L .'[ Ii:FIi'-.!T t'.,!.O I:~: H _E:i:[:
:il !::' THE
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11 ~
12
13
14-
15-
16-
17-
18=
19-
20-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99~;02 276.222~
SOILS LOG- PERCOLATION TEST
DATE PERFORMED:
$~TE PLAN
SOl LS LOG
PERCOLA,TION
TEST
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE /' ///,~ ~! (minutes/inch)
TEST RUN BETWEEN ?.~ ET AND ,~ . ET
PERFoI~M'E~D~BY:
72-008 {7/76)
CERTIFIED BY:
DATE;
C-
,::', M-W DRILLING, INC.
DRILLING LOG
Well Owner_ .Use of Well
Location (address of: Township, Range, Section, if known; er distance main road
'3ize of casing
Static water level
Screen (
Depth of Hole_ ~zFd~ feet Cased to__/6-/_~_~__feet
7~ ft. (above) (below) land surface. Finish of well (check one)
); Perforated ( ).
open end (
Describe screen or perforation
Well pumping test at /~/7_. gallons per ~~nut~ for
of drawdown from static level.
Date of completion
_.hours with
WEI. L LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
);
ft.
3--CONTRACTOR
Rick Mystrom.
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
June 19, 1996
Shelli M Vandiver
Kenneth J Vandiver
12940 Saunders Road
Anchorage, Alaska 99516-3237
Subject: Lot 6 Block 3 Mountain Park Estates Subdivision ~2
Permit 9SW950121, PID ~017-022-18
The subject permit, issued June 19, 1995 by this office for a
single family well and/or on-site wastewater system, has
expired as of June 19, 1996.
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 wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Si~erely, /~
~mes E. Cross, P.E.
Program Manager
On-site Services
eric: Copy of Permit
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 WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950121
DESIGN ENGINEER:DU/VKvfY COMPANY
OWNER NAME:VANDIVER SHELLI M & KENNETH J
OWNER ADDRESS:12940 SAUNDERS RD
ANCHORAGE, AK 99516
PARCEL ID:01702218
DATE ISSUED: 6/19/95
EXPIRATION DATE:
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES #2 BLK
3 LT 6
LOT SIZE: 19800 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
6/19/96
SPECIAL PROVI~~_ ~ , ~
RECEIVED BY:?~',------~ _~_
ISSUED BY:~~~_~~~~--~
DATE:
DATE:
/×o'~.4 ~-.
~ . Title Coml~ny ~ Ala,k,. ~ ,,,u~,- ~bll'~ ~
~ . f~ variations, If ~ny, ~ mpm~ ~Is ~ ~
~r, te et this lime. A revl~ h~ ~t ~n ~d~ "
T~ C~n~s ~ulre~ ~ any ~t~
¥ s .~ -'.
A~-~UILT ~' ........ '
~c~ ~" ~~ .....' ...
':: '~
, ~ ~. ~, ~ ~/~ //~ ~ o ..,.
L~:~:~ ~,.UD~ ~ · '" ''~
~~ .. ..... ...
0 It~ Pi~ , ' .'
~ $1~1 Pin . ~.:j. :~
· ~ ~k~...'.'...: ~-
I h~rc~Y Conifv th3~ ~ surv~Vof Lot ~ _, Bl%~ ~, ~ OF 4 "~ "~" ~'"
. .
'~~~?~~~ .- ~ ~,...,.~ 1~ ..:.,.....
~~ o~ ~.~ ' ~ · ''" "'
_, ~.' ~'~C~'~/......:.
., . ~9 .,. . ·
~ m* impro~m~nJs situ~J~d ~hu~on ~ri wi~in Jh~ pro~rW lin~s ~. ~ ~ . · ,~ ]~ I' ~'.
~ ~ ', ', ~ ,';'4.'-'
t y~, . ~. .....
Thls'as-bollt survey Is given as I courtesy, ,~wzt~ I
Title Co~nl:~nY of Alaska, Inc. asaum4s no ll~bllity
for vsrlafions, If Shy, nor represent~ thls Io be I
ecc~rete st this time. A r.vlew h.~s~ not been m~cl~
regat~ng su~fldeflcy of Itlls survey In meellN I
The COml~nY's requlrement~ loc any contem.
pl~ted or focthcomlng polJdes. ' I
·
O I~on Pi,~3
· ~1~1 Pin ·
a ~u~v0~ Hu~ ~ Tcc~ ~' E
~rc~Y C~ifY that a sur~ey of Lot _ . -,
...... A' /- '
Su~ivision was m~e on~ / ~ ' =~ . and
~t th~ impro~men~s situated ~hereon are wi~in ~he pro~r~y lln.s
~ d0 n0l ovorlap or encroa~ on the property lying adiacenl
~h~t no improv~mcnts on property lying adiacont ~horelo encrOa~ on
the premls:s in question 0nd that Ihero are no road¥~aYS, transmission
lines or o~r visible eoscmen~ on ~id pro~Y excepl
Oat~ Gt An~oro~e, A~oska, ~his~/ _d~V of~?z' ~ '
CONSTRUCTING ENGINE ERS
~RA Oox ~, An~or~Oo, Alaska ggS07
· '.- .... MUNICIPALITY OF ANCHORAGE '~
~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
· , · DIVISION OF ENVIRONMENTAL HEALTH
OF ON-SITE SEWER AND WATER'FACILITY
264-4720
: ' ApplicationDate ''1'~'//~-'J
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
~b) ~pp~cantName~W~ ~a~ ~e~epho~e:Home ~--?~q ~us~ess
Applicant Address I ~0
(c) Applicant is (check one): Lending nstitution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
:.'.?..i~ : Address '"~(~
"~'~ (fl -' Mail the'HAA to the following address: ' '
~<,~ ?,! ti//..,
:, .SE'?~J:~:~:;:~;~-;.~::t:¥}isL:~, ';~-,-': · ,: ,; .,'~'-":'-'.?,'-;: ":--):
. ~:}~::~{~}}~¢,.~i'~Z'¢~-~'~; 'M~lii_Fa~iiyD .:t0~~ ~-' .::?':/9
::: : ~.~,%?*:'~-~;';-:-;~,~;:'~%'¥~'~,-~:¢;;-) ,~ ~ .... '.-- '"~ .' ",-:, ~'~- .t~4:~-~:
~ ?~-,%:~Note fcommuntywe system musthavewrttenconfrmatonfromtheStateDepartmentofEnvronmenta Consewaton
::~.' .:~.~.~?:~a~e~tihg~thelegalityandstatus..'-'-..~{:.:,~'.F,.-,~%::<.'. · '.."-~-{' .-~:';~.'~"~7':.-t':..'~':%?~:2.'(~:~)~;:,;' -/'.~-~-~;'.~--~;:'-'..;.:":.
-* -.,.? ::_ :7?
Note: If community well system, must have written confirmation from the State Depadment of Environmental Conse~ation
attesting to. the legality and status.
- 72-025 ¢1/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING ..,SPECTIONS, TESTS, FILE SEARCH, DA'I ,-, AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation of this Heatth
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 invest{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
insl~ection. / ~
~////X(¢~//~ '- { - Engineer's Seal
Approved f~,,r ~;ed ro0ms by' ~~~~ :" D;;;'; ~/~/~/~ ~,
/ . - - - , ... :. ; /~- - ~. ' ./. ,-.
- ._ ~ .;. ..
~.. ,. '~, Disapproved /' ' '" ' '.'Conditional ' ' ' '"
;Terms o~ Conditional Approval .... ' "' ~ ' ' ': '" ' ' '~: .... ' ...... ~'~ ........... _
, . %'; , ,, . ,._ .'..:: ; ..' ... : :-. ,., _..~, ~,,-.-- ;... ~.. ,:," ·
/¢' i/(.f ~', ,' ' ' ';.'"~:' ::. '.":" ?~'.'?~'!'. _-" ' ;','-';-'.'".."." ' -
· .... ,,' ' ' ." .' ,- ",'. ";:- -. '.' ;. ". "~??'?.-~' ~-":' ': :':~'":-.r'.= ':."-;". ':' '
' CAUTION ' '-' '
The Muncipality of Anchorage Depadment of Health and Environmental Protection [DHEP) issues Health Authority
Approval ce~ificates basea ~olely upon the representations g~ven in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a coudesy to purchasers of homes and their lending
institutions in order to satisfy cedain federal and state requirements. Employees of DHEP do not conduct ins pections or
analyze data before a ce~ificate is issued. The Municipality of Anchorage is not responsible for errors or om~ssions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
, MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL -SERVICES DIVISION
NOV 1 9 I987
RECEIVED
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description:
WELL DATA
Well Classification 9£ i ~¢_ -~-~'
Well Log Present (Y/N)
Total Depth Z~ l ~ ~ Cased to
Static Water Level ./ 7¢, ~
Casing Height Above Ground ~
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot 1¢~0
To Nearest Edge of Absorption Field on Lot ,
To Nearest Public Sewer Line .&.[
Cleanout/Manhole /%[ A
Water Sample Collected by ~!~--P- ¢*-¢
Water Sample Test Results ~/~H-~¢:Rc
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ ~..~¢~)M Yield
Depth of Grouting (,h~ K~o¢
Pump Set At I¢/n
Sanitary Seal on Casing (Y/N) ~/'
Depression Around Wellhead (Y/N)
; On Adjoining Lots ~
; On Adjoining Lots :~ ! CO
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date I~/-'~4~/~ ?
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed o~/7¢
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line ~ ~'~-
To Water Main/Service Line
Course kt ~
Size /,d~?~:) No. of Compartments
Air-tight Caps (Y/N) \// Foundation Cleanout (Y/N)
Date Last Pumped ~ /V/-'~/~P7
; for
Temporary Holding Tank Permit (Y/N) /~ /z~_.
To Building Foundation "7 I
To Disposal Field c7 1
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026 IRev 8/86) Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~//~'/
Width of Field -~i
[(;)(;) .f~' .(".t //F,:J,','~. Type of System Design
Length of Field .~ ~
Depth of Field ¢¢/
Gravel Bed Thickness ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well j (jc~.
To Building Foundation ~
Lot kl /~
TO Water Main/Service Line
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line / ~'~ '~
To Existing or Abandoned System on
; On Adjoining Lots ;:;* -~ 0
'"70 I To Cutbank (if present) ~ ~
To Stream/Pond/Lake/or Major Drainage Course ~,1
To Driveway, Parking Area, or Vehicle Storage Area
Comments
L,FT
Date Installed ~,
Size in Gallons
"Pump On" Level at
High Water Alarm
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
* Check P/r~ttted Bedr(/o.m Rating Aga~HAA Request **
I certify thi~t I~a~'¢ ¢h. eckdCC/v~fied, or confor~ed to all MOA and HAA guidelines n effect on the date of this inspection
Date of Payment
Amount: $
Page 2 of 2
72-026 fRev 8/86~ 8ack
Engineer's Seal
CHEL14ICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343
5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D.#
~PRIVATE WATER SYSTEM
Name
Phone No.
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
~ Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
) [] Treated Water
/~ Untreated Water
SAMPLE
NO. LOCATION
.~.
31
4 I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No.
Result*
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count
_ Coilform/lOOml
BEFORE
COLLECTING SAMPLE
Verification: LTB BGB
Final Membra~su~
Reported y~~ .~- Date
CoilformllOOml
a.m.
TNTC = Too Numberous To Count
OB = Other Bacteria
PART 1 OF Z REMAINDER TO FOLLOW
,WORKORDER ~ : 3931
CHEMLAB REF # : 8348
· DATE PROMISED : NOV 18 87
CLIENT : CORWIN & AS$OC
REPORTS TO ~i :
ANCHORAGE, AK 99515
345-4440
PURCHASE ORDER #: VERBAL
REO # :
SPECIAL INSTRUCTIONS:
ACCT NO : CORWINP
·" WO DATE : NOV 16 87
nab IN~TRUCT.ONS VIA : HAND DELIVERED
Report~ Printed: NOV i6 8? ~ ].5:26
REPORTS TO ~2 :
SAMPLES RECEIVED : NOV 13 87
ORDERED BY : JERRY KRESS
Chemlab Client Parameter
Sample ~ Sample Description Matrix To Test Method Units Result
I L6, B3 MT. PARK, 11-13-87 I 20153'NITRATE-N mg/I /- ~
· ' APl-'1( ~NT FILLS OUT UPPER ....
Property Ow~ner ~+e~¼em V, ~&Cl~c~7'~0~'~
=~uyer
Address Zip Code
Lending Institution Phone
~Addmss Zip Code
RealtyCo.&A~nt HA&T~NI ~ L E S~AT~
Type of Resi~nce J
Single Family
Multiple Family No. of Bedroo~
~ Other
Water Supply ~ (~,
~lndividual A~ACH WELL LOG. A w~l log is required for all wells drifted since June 1975.
~ Community For wells drilled prior~that dale, give wall depth (attach log if available).
~ Public Utility
Sewer Disposal
~ndividual Year Individual Instatled:
~ Public ~ility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
D¢/~I~~ 7~'=:~ Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: Q _ ~'~/~ ,~.~, :¢,~j
( ~VEDBEDRO0'S3 f C,~ ~ /v'CONDITIONS OF APPROVAL
( ) DISAP~OVED ~?: m~/n ~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~f~ ..
~--'?~ Well to Tank /00 Septic T~k Size i~O :~
72.023 (3/82)
July 6, 1982
Mr. Stephen V. Backstrom
P.O. Box 10-1622
Anchorage, Alaska 99511
Subject: MNT Park Estates, $.~2, Lot 6, Block 3 i~{N Saunders
Dear [dr. Backstrom:
Approval for the individual sewer add water facilities cannot
be granted until the following items have been completed:
~ne water analysis report needs to be submitte¢] to this
office from the Che~ Lab, 5633 i.~ Street, for our review.
septic tank p~nped with a receipt sub~_~itted to this
depar t~aent.
An adequacy test needs to be l~rformed on the existing
leaching area. This test will determine if the system is
adequate according to National. Standards. A listing of
private firms performing ~e test is enclosed. ~£his report
needs to be submitted to this office for our review.
'l~e application shows ~]e number of bedrooms exceeds the
nun~er th~ on-site sewer syste~n was originally designe~
for. An upgrade will be required. Prior to any upgrade, a
permit needs to be issued from this department.
Please notify this Department for a reinspection ~,;hen the
noted cliscrepancies have been corrected. If there are any
further questions, }please call this office at 264-%720.
Sincerely,
Robert Co Pratt
Associate Environmental Specialist
Enclosure
ALASKA I FIUIROFlmi FITAL COFITROL $1 RUICI $, IFIC.
~§in¢¢rJn§ 8 (~nuJronm¢~tal SNJR:s
7/6/82
STEVE BACKSTROM
ANCHORAGE AK 99507
SELLER - STEVE BACKSTROM
SUBDIVISION-MT PARK ESTATES
ADEQUACY TEST FOR SEWER SYSTEM
BUYER-
BLOCK-3 LOT-6~~
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 432 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 1000 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 GALLONS IS INADEQUATE BY
250 GALLONS FOR THIS HOUSE OF 4 BEDROOMS.
, ~ Leroy C, Reid, Jr..~j/~
1220 ~est 251h Auenue · ~nchora§e, ~lasb 99503 · (907) 276-1361
DATE RECEIVED
INSPECTION
APPOINTMENTS
TIME -f.
TIME TIME
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE . ,5,'."
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION JAN t 6 1981
Telephone 264-4720
DlflEgTIONS: Complete 811 p~rts on p~ge ~. I~om~l~te requests will ~ot be proee~ed. Please 811ow ten HO) d~ys for processing.
1. P~OP~TYOW~[~ J PHONE
PhJ1Jp G. & Bsrb~r8 ~. RJchCerJ 3~5-~2g0
~A~UN~ADD~ESS ~ S~A
PROPERTY RESI DENT (~f different from above) I / .... PHONE
2. BUYER PHONE
Unknown at th~s t~me.
MAILING ADDRESS
3. LENDING INSTITUTION ~ PHONE
Unknown at thJs t~me.
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
E11Jot C. Lawson, 0ack WhJte CompanyI 277-1553
MAILING ADDRESS
3201 "C" Street, SuJte ~00, Anchorage, AK 99503
Send all correspondence and reports to Elliot Lawson at the Jack White Co.
5. LEGAL DESCRIPTION
Lot 6, Block 3, Mt. Park Estates #2
STREET LOCATION
Saunders Road ('~5~ on the left~
B. TYPE OF RESIDENCE ~
~ SINGLE FAMILY
[--I MULTIPLE FAMILY
7, WATER SUPPLY
I
NDIVIDUAL~
COMMUNITY
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
* ATTACH WELL LOG. A well log is required for all wells drilled L J-J,
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE** ~k~"~ ~-~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)--
.~ THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] 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
[] INDIVI DUAL/ON -SITE DATE INSTALLED ,--./
[] PUBLIC UTI LITY ~)
Connection Verified INSTALLER
[]Septic Tank JAr []Holding Tank
Size: /L~(~-~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~cAoPPNR~TVIEoDNFAOLRAPPR0~A~L I~:eDr RmOu..Ot~any certificate)
I~_~DISAPPROVED ~ ~J~ ~'
DATE ~ f-~.,~_ ~h ( ' BY /~1~~
72-010 (Rev. 6/79)
MUNICIPALITY OF ANCHORAGE .
825 L Street- Anchorage, Alaska 99501 .
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 .
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete aH parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PROP~T~DEN~f~ntfromab2~ ~ ~ PHONE
MAILING ADDRESS
i5. LEGAL DESCRIPTION
STR E,.~T LOCATI ON
6. TYPE OF RESIDENCE
~r SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
fl~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
3
NUMBER OF BEDROOMS
[] One [] Four [] Other__
[] Two [] Five
,~ Three [] Six
* 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
~ INDIVI DUAL/ON-SITE** **If individual/on-site, give installation date
~ If system is over two (2) years old an adequacy test is required
[] PUBLIC UTILITY 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
INSPECTOR INSPECTOR INSPECTOR
D~RECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY [] ONE ~ THREE [] F IV ~:' [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
"~ INDIVIDUAL DEPTH OF WELL
[] coMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Cohnection Verified LOG RECEIVED
3. SEWAGE; DISPOSAL SYSTEM PERMIT NUMBER
-E~ INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~LIg~
Connection Verified. INSTALLER
'[~]Septic Tank or [] Holding Tank ~',
Size: I~l~:b. If Tank is homemade SOIL8 RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
I 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area JSewer Line I Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~APPROVED FOR5 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL DESCR-IPTION ~
72-010 (Rev, 3/78)