Loading...
HomeMy WebLinkAboutPREUSS #2 BLK 4 LT 5Preuss #2 Block 4 Lot 5 #050-571-44 DE ATMENT OF HEALTH AND HUMAN SER ZS Environmental Health Division " 825 " L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name -�C�-- c'Y- t ra" DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address /T r ✓�//n/ Phone(s) Permit No. No. of Bedrooms A76 ^13 1 -3 lei I& I LlLOT WELL Mg In s - LINE / �O ,'-yrs,. t SCJ NY fcrr 7� l ✓ LEGAL DESCRIPTION Lot j Block Z/ Subdivision f'G�/: I -rs FOUNDATION / 31 � 1- G 3 � Township, Range, Section �y /Y ✓ �- W s e- r- AS -BUILT DIAGRAM driveway, water bodies, tShow location of well, etc.) septic system, property lines, foundation. TANKS r �i SEPTIC ❑ HOLDING Manufacturer Capacity in gallons Material _ !) No. of Compartments G/ - M v TYPE OF SYSTEM ® TRENCH ❑ BED ❑ W. DRAIN []OTHER Depth to pipe bottom from original grade FT Total depth from original grade FT S rw LyS i it 0 >I �� a i` for gran Y r"ib Fill added above original grade %-- FT Gravel depth beneath pipe FT Gravel length 9�3 FT Gravel width .3 FT Total absorption area 6uly SQ FT Distance between lines FT ' IN Number of lines 3 Soil rating f SOFT Pipe material AS h, 3a :3 y Installer Date Installed WELLS F4 PRIVATE ❑ OTHER (Identifv) Classification (A,B,C) erI1/4 "C Total Depth FT Cased to FT Installei Date Installed: i REMARKS: lona / rej✓ c.d, Gt ol�ceat cis �9'ni %O '% S&gle River Engineering Services I Eagle River, AK 99577 ENGINEER'S,SEAL `- v l c.n uCC.,D G�=quo 000aoo o - l F � `^ New 4�S� ��✓fz ii✓S7<f�e Date 694.5195 f l _ I cenily that this - L. - inspection was performed according to all Date: Municipal and State guidelines in effect OrVf I date: Health Department Approval: 72-013 (3/85) v I U ` 'I' if ����� �� ����-������ , � DEPARTMENT\-d� HEALTH AND ENVIRONMENTA&�/ROTECTION L STREET, ANCE HORAG, 0 AK 9951 264 ..... 4720 --G��N0, H-- P" w -0-~h PERMIT NO: 860216 UPGRADE DATE ISSUED: O7/03/86 [� e^� / u � l5'�� � ��^ �� APPLICANT: PET TER��ARRAT N[)RT|^|ERU'qL.I(_7!~|S ANCHORAGEr AK 99503 CONTACT PHONE: 276~1333 LEGAL DESCRIP: \/ISION:``PRUESS ' LOT. 5 ^ BLOCK: 4 � SEC[ION: B TOWNSHIP: 14N RANGE: 1W LOT SIZE: 22000 (SQ"FT, (jr., ACRES) I certify that: 1. I am Yamiliar with the or on-site sewers and wells as set {orth by the Municipality nchorage (MOA> and the State oaska. 2. I will install the system in accordance with all MOA codes and regulations, and i� compliance wi.th the d s permit, 3, I wil� adhere to all MOA and State of Alaska requirements [or the set back '!istances /rom any existing well� wastewat�r disposal system or public s.nerage system on \his or any adjacent or nearby lot^ IF A LIF| SlATlON IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL I'M BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WO RK I" F 'INSED ELECTRICIAN, SIGNED APPLICANT: PETER GRRATT ISSUED BY DATE: y _ aetd2 -Smv_~� A'tl SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 _ 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: '" �' ��� Shu r� /*iDATE PERFORMED: LEGAL DESCRIPTION: Y -O L7 /3 /oc,k 1 aMM �ol)so0 G P - G /n 5kn C( -1 Grc vel PaGr 4T4c JS %7 SUI.>.oC 16 a 18- 19 8 19 - <1 1t,i Louis A. fSutera o i4,F�j Cu -5736 Fj 20 ' Q` o0 oo oeoao' c NONE ■ 'N■ ■■I1■ MORE N���� ■■I.. MMIEN ■■N■ 14 /2//y Sec, 8 SITE PLAN WAS GROUND WATER I'eS S ENCOUNTERED? O U. ✓� 6IaNI&5- — /,/ %� P IF YES, AT WHATE DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop kOT[?;Sln� - PERCOLATION RATE SSU��,�, (minutes/inch) TEST RUN BETWEEN FT AND FT ✓� S �.2 Grave( COMMENTS 1'-,Y' t/ecL7r.� dr.-. u �rc<�e � % Ye •� t � /V %a. %. Q, i � p / /0, cell soa PERFORMED BY: Eagle River En$fnN*rtn#,gRry[GQg CERTIFIED BY: /� DATE: 7 6 11-0-84 k773294o, Eagle River, AK99577 72-008 (6/79) 694-5195 i Wim/ Val E �- 07- -_ E) /6d}fS (y'd';'�-ir. ' i.s, �Rii ����<fr9�i`r •tai �) ro 2225-E A6.4,,13', JUNE 254 �',,. i � �-�"' / aG d ,nom•, S� .:,r �Y'O�-�/t'fs!'I C --"L7 �te' ( „ � ����t "'�:®o.o ss•�A ni,-�s 1_ t2 1 I C� �t)Ni?1 fid`= -=i t7/: `.� L D, 4 , T us. s wo.. � ((( I ,� G'a ✓.mow' I{� SUS a >., O Co N D — 4- corT0<-o./ moi �i Oo"� A � ' _ �a 7>AVID. 0 FDg,��d� . 04 °¢ ° ,ASAItB U� 7t is the responsibility of the owner to determine q 9e the existence of any easements, covenants, or re- ; : I°"'�` K°r{ Dowling ;t< strictions which do not appear on the recorded sub-: g���F�'•, 15645 Q��'.I division plat. Under no circumstances should any »;.. �F°��°°°•M°•••''ao5'; OFESSICBAL VA f lira Hereon be us=d for construction or for estab- `'NOTE lishinq boundary or fence lines. The surveyor takes EASEMENTS OF RECORD, OTHER THAN THOSE. responsibility for the initial transaction Only. SHOWN ON THE RECORDED PLAT, ARE NOT r _ SHOWN HEREON. LEGEND LO._ 9LOCK 9 BRASS CAP MONUMENT - �.eG 5vlenl I// S%Q A,� ' O IRON PIPE f PLAT NO. J ® REBAR PROP. COR.FNU HI4CHORAGE RECORDING IS T RICT ❑ NOB a TACK --- PaEPARlE_T 8Y: LOWLINC & ASSOCIATES ---- 142E Hvder Street ANCHORAGE, ALASKA 99501 EVISION CaTE: BY: SCALE: �I- WORK ORDER: FIELD BOOK: GRID: D : ; ,%—¢/ July 15, 1986 John Kennedy Municipality of Anchorage P.O. Box 196650 Anchorage, Alaska 99519 REF: Lot 5, Blk 4, Pruess Dear Mr. Kennedy, The following is provided per your request as an explanation of the septic upgrade inspection report dated 7/9/86._ J Due to problems with the existing leach pipe elevation, the leach pipe was lowered by 6" in the existing 3 bedroom trench installed in 5/85, reducing the absorption area of this trench to 432 sq. feet. A percolation test required by Steve Morris increased the soil rating to 166 and therefore 664 sq. feet of absorption area was required for a 4 bedroom capacity. the additional trench consists of a-15' section at 4' of gravel and a 20" section at 4' of gravel for an additional absorption area of 280• sq. feet.• This gives,the septic leachfield a 4 bedroom total capacity rating. The original septic tank was replaced by a 1250 gallon tank. The original crib was abandoned. If there are any questions, or if additional information is required, please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. MUNICIPALITY OF ANCHORAGE cc: Tobben Spurkland DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION J ei 5 "1 EAGLE RIV ENGINEERING SERI r6ES INC. P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694.5195 Zgi JOB f 2 ><-S- '%*'£/ d lc�l`&,-, ' SHEET NO. OF CALCULATED BYDATE CHECKED BY DATE_ SCALE /✓,7.T, 0 PROWT 2a I a Inc., Groton, M.01471 -/ 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 PHONE NEW d vv O P4014C t IF ADE MAI LI&9 ADDRESS S� gam' LEGAL DESCRIPTION L S /3 4/ e LOCATION SO T! 'f � � w NOOF BEDROOMS . .3 U Y DISTANCE T0: Well o ,� Absorption apea Dwelling / !- y[ V PERMIT O. .TN5., //� l `AJ 1G?7 7 d (YAG wQ Manufacturer /` L Material / W y e No. of compartment;/ NI.- Lie. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth O z DISTANCE TO: Well Dwelling PERMIT NO. 2< = Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well U Q Foun�tior�/ 7'- Nearest ��ne t� PEI M3 NO (� Z �- X No. of lines / Length of e line/ Total len q.�lin�6 t`J Trench idth i� 0 inches Distance bet:vye2n lyn es^ /" ! �d- I.. Top of tile to finish grade S Material beneath tile / st Total effective absor on/rea b d inches Z/Lu g0 Lu Length Width De �h� /h, c- mitis a&9 PERMIT NO. LAt ` 4 --� Q I- as w Type of crib Crib diameter Crib depth Total effective absorption area U DISTANCE TO: Well Building foundation Nearest lot line Class r- L s 7/ D p h pieG v rill r Distance to lot line PERMIT NO. J LU 3: DISTANCE TO: Building f undation Sewer line Septic tank Absorption area(s) OTHER L W ( t PIPE MATERIALS t/ SOIL TEST RATING /S6 gle t INSTALLER G r 13 s XExGa vc�, //02 REMARKS Lo i At;- ¢ 7/ (' G �L„+` ]R N l.nofafh to-nY 4 RRRR e�a-�. 5 r5 � �• G? P�OFkS�,l0�3P-Alp' d APPROVED GREJ DATE LEGAL � j'1�p0aA} JJrt �� Et} CJ ZO r�v 4 c-vio nev. aiio� PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: ����� � DEPARTMENT OF HEALTH AN� ENVIRONMENTAL PR�TECTIO� 825 L STREET, ANCH�RAGE� 264`4720 LEGAL DESCRIP: SUBDIVISION: PREUSS SECTION: 8 TOWNSHIP: 14N LOT SI��: 20000 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 '- - Yke e-7 �� / � c~jel6~ LOT: 5 BLOCK: 4 RANGE: 1W ** TANK MUST HAVE AT LEAST TWO CO�PARTMENTS ❑ SOI LS LOG MUNICIPALITY OF ANCHORAGE e �c DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 1 , tl&Xho, PERFORMED FOR: U�D0 &jo"Lx E DATE PERFORMED: SN LEGAL DESCRIPTION: G 6 D �(i{ ,S ,S / L) DEPTH I /1 /C SLOPE SITE PLAN VF CYP7--g v c 2 /� r 3 /` o 4I KT - 5 rt 5P (r G7 7 8 `. (7 9 U `( 10 /' i 14 G �j j Net Time 11 Net Drop WAS GROUND WATER �[/O S �i 16'/ ENCOUNTERED? L �-'p Y3 ��YC�il6 Q 02 A 09000 OF,�� O 12 i P ,} &obers A. Shafer .' Qv •S' / �3,iP°Ba IF YES, AT WHAT E 19 G pROFESSI�N��.� DEPTH? 13 l i 14 Date �j j Net Time Depth to Water Net Drop 16'/ �-'p Y3 ��YC�il6 Q 02 A 09000 OF,�� 17 e ..a Be .o •o• ••• eee aeBpe�� ,} &obers A. Shafer .' Qv •S' 18 �3,iP°Ba No. 1457•E ,•' 19 pROFESSI�N��.� 20 COMMENTS PERFORMED BY: 72-008 (6/79) Reading Date Gross Time Net Time Depth to Water Net Drop Af PERCOLATION RATE //T (minutes/inch) TEST RUN BETWEEN FT AND FT �+y ntt1:,!] DVIYVT," t\ J"II�v11V RMVG DVRVYVf' AepartmeMRGM nt Ot Environmental Quality �.. 914 350Q Tud�SrRoad — Pouch 6 mom'— -"" — ^ - - - - ar lr PECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM R��� MAILING , - ' NAME L7E!L-in�C1 8,u/4eaNI=S ADDRESS#LbY &)6tCdIZ-ul7P_Lk QT���. PHONES i,50 14 LOCATION Cit F L?44C- 'EfVEP PQ LEGAL DESCRIPTION / 1- i 134.r -4 SgRj) SEPTIC TANK: DISTANCE FROM WELL 3(z rt NUMBER OF MATERIAL COMPARTMENTS 19'72.-C� Uel LIQUID LIQUID CAPACITY /000 GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH — SEEPAGE SYSTEM: NUMBER OF P SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH 7 LENGTH/& e17 DEPTH 9 � i LINING MATERIAL em-�'71 �1�45 DISTANCE FROM WELL/ia f BUILDING FOUNDATION, 1 NEAREST LOT LINE ✓�� ��r >> TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)—S 9 SQ. FT. TILE DRAIN FIELD: DISTANCE FROM NUMBER OF LINES ABSORPTION AREA FOUNDATION , ISTANCE FT. LENGTH OF EACH TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO DNTSH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE MILL D / DEPTH 330 DISTANCE FROM BUILDING FOUNDATION. EEC)('. WATER SAMPLE IJ0645 NEAREST 1 NEAREST SEPTIC LOT LINE LO 4- SEWER LINE 4/' TANK ,_ SEEPAGE ,� O SYSTEM OTHER CESSPOOL ,IJP&f SOURCES 1,16a, J DISTANCES: •fir 7G /' = /G�� %/ DIAGRAM OF SYSTEM DATE �/ �%L!J/ /Z' /o/z APPROVED 00L&.R l- - l.d ka-&U� �- HEALTH AUTHORITY :ll Owner_ 51, Location M -W DRILLING, Inc. P. O. Box 4-1728 ® 2811 Dawson A C 907-279=1741 ANCHORAGE, ALASKA 99509 avl DRILLING tOG A - (address of: Township,: Ran e. -Section'. -If known; or distance main road _ �r AO e of casing___ -.:_.Depth of Hole„_ feet Cased to , _� feet itic water level _2% ft. __ e) '(below) land surface. Finish of well (check one) open end ( X ); Screen ( ) : Perforated Describe screen or perforation - 11 pumping test at 6 gallons -per ( ) (minute) for lours with of drawdown from static level. - Le of completion_ MnV� :Z - i s t.. ? y Z✓taa��, WELL LOG pth in feet from - - ,und surface Give details of formations penetrated, size of material, color and hardness O TO 6raY'el ;_vim to Wt.d2oecai f ersa�l eehb'1 ws - -.10—TO 3t) Y _.V__TO_�� Si 1 •tv tar t -3-4—TO'76-- Sa nA It rar gv e l 1,6{cr a a'- 4r► q - -: r W - I n 95 TO�r t• 2� TO i-� ..1 -TO �] ..2n i To---2.W— _. O _.3 m 2Rn �C�TO300 ATO -1.20 _S=T0_..__ M0 Nim Ho ,33C2.T0 Y 3—Contractor _ GRE} F_ -R' ANCHORAGE AREA BOtrozrH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6.650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO. !=//� �E� `' �/////LSO✓✓ iE�./i�G�r C/�� � - �ti NAME OF APPLICANT�� MAILING ADDRESS/ 'PHONE INSTALLATION LOCATION LEGAL DESCRIPTION Y/�/C i -f�"�� ����L ��'�'� aN ��>✓rL/ INSTALLATION OF: SEPTIC TANK � SEEPAGE PIT L DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED -3 ��7�eaL�� _i ���G'L>�� �✓�fiJ� FINANCED THROUGH �� TO BE INSTALLED BY �F�C/i�//✓l SOIL TEST RESULTS �/�P�y E%9/1G� NOTE: T PERMIT IS NOT VALID WITHOUT SOIL TEST o Testi T 6G� COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE - TYPE ���2Z«SEEPAGE AREA SIZE TYPE -�C-� G��=•'� MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT U DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL l SEPTIC TANK 3' SEEPAGE PIT � U DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ✓� ` SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT LlL— SEPTIC TANK, =�-i SEEPAGE PIT �U�J DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB 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. HEALTH AUTHORITY OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. /J DATE APPLICANT'S SIGNATURE ORDINANCE NO. 28-68 AND THAT THE ABOVE __,ER ANCHORAGE AREA BOROU� DEP`kTMENT OF ENVIRONMENTAL QUALIYf CASE # 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For ,roe SrhPffield Date Performed May 19 1972 Legal Description: Lot 5 Block 4 Subdivision Preuss ® EaZlc . River This Form Reports Soils Log X Percolation Test Depth Feet Soil Characteristics 1 -- 2 — 3 — a 5 -- 6- 7 9 — 10 — GMT Silty Sandy Gravel SF Poorly Graded Sands Was Ground Water Encountered? no If Yes, At what Depth? rd M Reading Date Gross Time Net Time Depth to H2O Net Dron' i Percolation Rate P9in1ita Proposed Installation: Seepage Pit X Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench COMMENTS; 175 Ft2 should be alloyed for seer-epe per bedroom A hole 22X22 feet was recommended Test Performed By Data Certified By: Date: i 0 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 S0 — 5 *7 44 `� HAA # 1. GENERAL INFORMATION Complete legal description Preuss #2, Lot 5, Block,4 T14N R1W Section 8 Location (site address or directions) 10117 Eagle River Lane, Eagle Risser, AK Property owner Fred & Maria Gerber Day phone 694-4200 (msg) Mailing address c/o ReMax - Sharon Minsch Lending agency City Mortgage - Warren Gossett Day phone 696-0701 Mailing address 11401 Old Glenn Hwy. , Eagle _River-; AK 99577 Agent RPMax - Rharnn Mingcb Day phone 694-4200 Address 16600 Centerfield Drive, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 l/ 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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 lZu VOW MD89 (1,15/1 'ney) SZO-U 'pl siaaul6ua leuolssaload agl u, suolsslwo ao saoaaa aol alglsuodsw lou sl a6eaoyouV to A111EdlownN agl 'panssl 's1 aleolpliao a aaolaq elep azlleue ao suolloadsul lonpuoo lou op SHHa to saa (oidw3 -sluawaalnbaa alels pue leaapal uleuao�Clsllesolaapao ui suollnll;sul bulpual Jlagl pule sawoq 10 saasegoand of Csalinoo a se- slgl saop SHHa 941'e�selV 10 91e1S aql ul paaalsl6aa Jeaul6ua leuolssaloid luapuedepul ue Aq anoge g gduibuied u1 uanl6 suo!lleluasaidaa aql uodn Aluo paseq saleoll!Ua0 ilenoaddV A1!ao41nV 411e9H sanss! (SHHQ) seowaS uswnH pue glleaH 10 luawliedaa a6eaoyouV 10 4.1edlownN eqj — o — e1ec] !� fes( .A8 102a 7 7/ /) / M 3S 7 sluawwoO leuolllPpV suollelndlls 6ulnnollol eql ql!M 'swooapaq S3roy d Vr ry�T DJo:n� 4 .e Vs .x -ar tre.,• q 101 lenoidde leuolllPuOO Pano.iddesla swooapaq / ao1 panoiddV —3<— �j 3un.LVNJIS SHHQ 9 LL966 MV ' aanTH GT ainleu6ls s,aaaulbu3 7v6ZELL X02 'O'd ssaappV 56T5 -b69 au 8 4d saO FAJGS 6uT.zaauT6ug =anzg aT6eg wild 10 aweN 8 9Toquem oT TTaM pue ',pg auTT =aMas 04 TTaM Jo .zanTeM u4TM -uolloadsul slgl10 alep 941 uo 109119 ul suolleln6aa pue saoueulpao 'sapoo alelS pUe led!o!unW Ile 41!^^ aouelldwoo ui sl walsAs lesodslp aallamelsem ao/pue Ajddns aalem a11s-uo aq1 'uolloadsul pue uo11e611sanul AW woal pue sal!1 a6eaogouV 10 Al!led!o!unW aq1 woal paulelgo uollewaolul 941 uo paseq 1eg1 Al!aan aaglanl I 'ulejgq paleolpul ainlonals 10 adA1 pue swooapaq 10 aagwnu aq1 aol alenbape pue leuollounl 'ales sl walsAs lesodslp aalernalsem ao/pue /Iddns aalem a11s-uo ag11e41 SmOL1s uo!leo!Idde lenoaddV AluoglnV 411eaH s!4110 u011e611sanu1 Aw 1eg1 A1!a9n I Imolaq unno4s eleP u0111 llen ag110 se pue olaaaq PENAU leas Aw Aq pa!1!liao sV a33NION3 AS NOLLOUSNl d0 LN3W31t11S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST _ Legal Description: A/ZZU55 /-0T5' �jj�l� j� parcel I.D. A. WELL DATA Well type /��/y�1Ta If A, B, or C, attach ADEC letter. ADEC water system number /U14 Log present (Y/N) %SES Date completed 0 1_a5472 Driller A Total depth 333 / Cased to 33 ;?--' Casing height // 7 Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Ye s FROM WELL LOG boy Wires properly protected (Y/N) yo E g.p.m. fj(/��l N4dN SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot &) 5 AT INSPECTION �c oCo�i�9 Z $ z 300'_ rri na.. r Z Y /-,300/ 91{x•m _ U't � mn N o O 70 `n m z On adjacent lots Absorption field on lot X00 —;On adjacent lots Public sewer main D Public sewer manhole/cleanout i Sewer service line �_ /I- t2 Petroleum tank NONE .f22AC6/tl7 WATER SAMPLE RESULTS: Coliform Nitrate 0' ���ZI— Other bacteria Date of sample: Collected by: FiVhJIJEi✓!p B. SEPTIC/Het6H G TANK DATA Date installed 07VA09I7(0 Tank size / -Z-6 0 Compartments I Cleanouts (Y/N) yES Foundation cleanout (Y/N) Depression (Y/N) M9 High water alarm (Y/N) NZA Alarm tested (Y/N)ILA Date of pumping ")(O//0/n, Pumper J_[j SEPARATION DISTANCES FROM SEPTIC/FSG TANK TO: l Well(s) on lot • m �5 On adjacent lots /--/001 Foundation To property line -Absorption field 13 Water rnak+3 service line— Surface ine Surface water/drainage AVA 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: LVITMIllre D. ABSORPTION FIELD DATA On adjacent lots 4_ "Pump off' level at Cycles tested Surface water . Date installed 1!2Y6 Soil rating 1&0 0 BE System type �26WOla Length g3 i Width � 3 Gravel thickness Z� Total absorption area bbjj 01 Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) 10A5 Total depth vis Date of adequacy test obollq Z for Peroxide treatment (Past 12 months) (Y/N) Nf� If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /©O 7 On adjacent lots -74100 ! Property line bedrooms i To building foundation To existing or abandoned system on loth= On adjacent lots f �O r Cutbank /`! / .4 Water main/service line Surface water NI4 Driveway, parking/vehicle storage area y Curtain drain 1v1/4 E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Itte�t� of this inspection. 4 3 `yid ; ,, • b° 14, Y' Signature Engineer's Name �U� . r �y �rrL. �.. ...................°;°, i Louis A. 6utora W P Date h47/99 ®� iP+'a CE -5716+r HAA Fee $ Z 70 CT�7 Date of Payment Receipt Number 12I, . ,on.. 11011 A.,4 AInA 91 Waiver Fee: $ cad (() Cl Date of Payment Receipt Number Municipality of Anchorage • � M1 _.2 4 Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 28, 1992 Lou Butera, P. E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Block 4 Preuss Subdivision #2 Waiver Request #WR920032, PID #050-571-44 Dear Mr. Butera: Your request for waiver of the required 100 foot separation of a private well to public sewer manhole and public sewer line have been approved. The approved distance separations are as follows: private well to public sewer line 60 feet and private well to the public sewer manhole 88 feet. These approvals apply to the existng well and public sewer manhole and public sewer line only. Any future upgrade will require all separation distances be met or another approval from this office. /SSii-'n1cceer�e�l� y ,, fDaniel J. Roth Civil Engineer On-site Services ljm#9 Jro cur: n Sm'th, P. E. gram Manager On-site Services IVrrI v c..\ ff%{{K ja%1 rV IA T //idr. K .0 V I fuAlvEIQ REQuEsr aurtBER t..x92o0.�2 "EST ro P,,&tr SEw£R Li F, 60 VC IPE SPEC I'1 ✓ EL Y. i M rt'Gt--- _-'C_fAffffC-M-r GC7--/ 44-E, -- - -- NT OF- TKE�ftaLE_NASLrW,E — ��v�--- i A) T / L,/ t » ` / I. I .. r n �. r n /O�J� .n I i � • _ _ w .. n _ _ LL t' REvArr JWRmcE A Q w 1FG 14. it 1 No BA c TE 91-4,_ LiNE_oAra _-_- -- -; - S E w► �n L / u �— �,,, � l.v_S� L L ED /v__ / �8 4 .4 fT'ER Tk�' _ �..f c c — -- rt'Gt--- _-'C_fAffffC-M-r GC7--/ 44-E, -- - -- NT OF- TKE�ftaLE_NASLrW,E — ��v�--- i A) T / L,/ t » ` / I. I .. r n �. r n /O�J� .n I i � • _ _ w .. n _ _ LL t' REvArr JWRmcE A Q w 1FG 14. it 1 No BA c TE 91-4,_ Emah, Rbew Ensluen'Ans SQrwIlrlQz Louis Butera, P.E. Registered Civil Engineer June 29, 1992 John Smith, P.E. Municipality of Anchorage Dept. of Health & Human Services 825 L Street Anchorage, AK 999502 Re: Preuss #2, Lot 5, Block 4 Dear Mr. Smith: On behalf of our client, Mr. Fred Gerber, we are applying for determination of a waiver of separation distance for the above referenced single family property. The requested waivers are for private well to public sewer line of 60', and private well to public sewer manhole of 88. It was determined that no waiver exists on this well, although it was required in 1982. The well was drilled in 1972 to a depth of 333'. The sewer line was installed in 1984, and is constructed of ductile iron pipe with concrete manholes. The surface topography of the area is such that the road forms a drainage channel with a slope to the south, perpendicular to the direct well to sewer direction. Any coverage existing to the ground surface would likely follow the road drainage away from the well. This slope is indicated on sewer line asbuilts enclosed. Immediate sub -surface soil is a GP -GM type sandy gravel with silt, with a water table at 14.5' depth. The single most supportive physical evidence in favor of a waiver approval is the consistent well depths of 330'-350' in the local area. The well logs show penetration through various sand and silty gravel layers to the total depth of the casing with a static water level just above the terminus of the casings, and a good production rate with minimal or no drawdown at residential flow rates. The well has never had a bad water sample, and nitrate levels are below detection limits. The subject well is 333' deep, and has a static level of 298' below ground with zero drawdown at 5 GPM. The well directly across Eagle River Lane (west) is 347' with a static level of 296'. This well (Colonial Park, Lot 1, Block 3) was waiver approved for a 90' distance to a leachfield location in 1987. 1.11 -9 R P e 32'9�' ka -A; 99nl c) P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 Page 2, Preuss #2, Lot 5, Block 4 Waiver application Attached are well logs, sample results, AWWU plat and other pertinent information regarding this waiver application. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. 4 MUNICIPALITY OF ANCHORAGE�=.' DEPARTMENT, OF HEALTH AND ENVIRONMENTAL PROTECTION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 0 7- �!-j -pp-Euss Nzlsiffe -41,00 -Tlve\l Location (address or directions) 10//2 a 2f 61Qhc� (b) Applicant Nar Telephone: Home 976-/333 Business Applicant Address ;Z0 7 tq_ LRIVO�P (c) Applicant is (check one): Lending Institution El ; Owner/builder 1:1 ; Buyer El ; Other El (explain); (d) Lending Institution Telephone Address Oq (e) Real Estate Company and Agent N&VytA,-A Address kF- N, L_, 2 1� Telephone A74 (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE :Single -Family Multi -Family F-1 Other Number of Bedrooms 3. 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. 4.1 SEWAGE DISPOSAL OnsiteeK Public 0 Community El Holding Tank ❑ 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 72-025 ( 11 /841 ;;jENGINEERING FIRM PROVIDING,, aSPECTI ONS, TESTS FILESEARCH, DAT��,­AND INFORMATION As certified by my seal affixed hereto and as of the validation cate shown below, I verify that my investigation bf this He6tih 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 effecton the date ofthis inspection. Name of Firm Address A0 / S—k4 Date OF AM ` Engineer's Sou .NE 25, 1971. � v ' v ^ ~ 6. 08EP APRROVAIL(�) ~pp'",e" for """'"" V4,tl —Date Approved A Disapproved Conditional Terms ufConditional Approval ' � ^ ' ' � CAUTION . ` The MunuipditymfAnchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5above byan independent professional engineer registered in the State of Alaska. The DHEPdoes this oaucourtesy tu purchasers ofhomes 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 2of2 MUNICIPALITY OF ANCHOR A"> DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) , 0 3� CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Lo7- 5. AV ya as pa Kt A. WELL DATA Well Classification -� If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _ Date Completed 076 7B Yield Total Depth 3'52. Cased to rPZ- Depth of Grouting N+O�NAr Static Water Level 020 Y Pump Set At Pa TTC A4 Casing Height Above Ground Sanitary Seal on Casing (Y/N) V Electrical Wiring in Conduit (Y/N) 7 Depression Around Wellhead (Y/N) N Separation Distances from Well To Septic/Holding Tank on Lot Joel' ; On Adjoining Lots Ja-G To Nearest Edge of Absorption Field on Lot 1" ; On Adjoining Lots To Nearest Public Sewer Line NCH C To Nearest Public Sewer Cleanout/Manhole NrJNtr To Nearest Sewer Service Line on Lot / C� Water Sample Collected by A•40 ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA P2 ARS p Date Installed Size No. of Compartments Standpipes (Y/N) ? 4'/0 Air -tight Caps (Y/N) — Foundation Cleanout (Y/.N,) /—y Depression over Tank (Y/N) 8 Date Last Pumped � � tX/ Pumping/Maintenance Contract on File (Y/N) 14116t' ; for NIA Holding Tank High -Water Alarm (Y/N) UZA Temporary Holding Tank Permit (Y/N) W44r Separation Distances from Septic/Holding Tank: To Water -Supply Well Ito To Building Foundation To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) I To Disposal Field ! To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �(0 Type of System Design 2TO JENC n Date Installed r'�!J 4 %4%/?8& Length of Field I/s S� Width of Field Depth of Field 1® • g Square Feet of Absorption Area Depression over Field (Y/N) — Results of Last Adequacy Test Gravel Bed Thickness (p Standpipes Present (Y/N) / / Date of Last Adequacy Test bj� L��� a Separation Distance from Absorption Field: To Water -Supply Well +/ D b To Property Line 18 To Building Foundation g✓ To Existing or Abandoned System on Lot 'ec ; On Adjoining Lots % ., Z) _ To Water Main/Service Line > 10 To Cutbank (if present) ti 0 ti 4 To Stream/Pond/Lake/or Major Drainage Course O L� To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION j j 0 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verifie or conformed to allll MO.,A and HAA guidelines in effect on the date of this inspection. Signed Date �``o� " 6 Company MOA No. Receipt No. 3q y y �e�.•• <;b !/���od 1mr . et Date of Payment 7-; �,ty e3 r • Engineer's Seal Amount: $ it a N 222_5-t 1 25, 1971 = Page 2of2�, �t 72-026 (11/84) t 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 1. GENERAL INFORMATION (a) Legal Description (include jjlot, block, subdivision, section, township, range) r Location (address or directions) (b) Applicant Name Telephone: Home 5--s;ness Applicant Address — -- (c) Applicant is (check one): Lendingt Institution ®; Owner/builder O ; Buyerj9; Other D exp ainf; (d) Lending Institution %t _ Telephone -- Address — — (e) Real Estate Company and Agent -— — Address — — -- Telephone-- (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family O Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well lJ Community O Public Note: If community well system, must have written confirmation from the State Departmentcf E ,,;ronmental Conservation attesting to the legality and status. l. 4. SEWAGE DI POSAL Onsite Public O Community O Holding Tank -, Note: If community well system, must have written confirmation from the State Department of En,s€ronrne ntal Conservation d attesting to the legality and status. Page 1 of 2 - 5. 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. �•_ Name of f=irm � � � Telephoner Address I / fir! f - 8 &_61 re ! � ems .-- Date 7'/ 8'��-' 6. DHEP APPRO Approved for �_ be( Approved [ Terms of Conditional Approval CAUTION tional Engineer's Seal Date 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 lel -.17 /11/RAI A. WELL DATA � p�UtVclkdNICIPALITY OF ANCHORAGE (MOA) V®t1R` EALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 t Legal Description, V � tion, F (' �, S e+ e+//Q/,1 Well Classification L [ '1liT(— If A, B, C, D.E.C. Approved (Y/N) J Well Log Present Y�V) Date Completed 11.-8-� 62 Yiel C' Y ` IA Total Depth j qo Cased to Depth of Grouting A Static Water Level 4 � '� Pump Set At 6T r) Fluu f-() Casing Height Above Ground _L111t7 r Sanitary Seal on Casing CN) Electrical Wiring in Conduit. Y/ ) Depression Around Wellhead (Y/O Se aration Distances from Well: P '4– To Septic/Holding Tank on Lot . ; On Adjoining Lots = � To Nearest Edge of Absorption Field n Lot X219 On Adjoining Lots l® To Nearest Public Sewer Line �� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 4 Water Sample Collected by q ei+ Date ��--.�- Water Sample Test Results 4-sSfCA C­6^�–� Comments well F'6L'J B. SEPTIC/HOLDING TANK DATA Date Installed Size /000 No. of Compartments Standpipes ON) Air -tight Caps&) Foundation C.II ano t it N) Depression over Tank (Y& N p Date Last Pumped 7) �7'_DC4 7Z5!! ' N Pumping/Maintenance Contract on File ( r ; for Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N) ��— Separation Distances from Septic/Holding Tank: I� To Water -Supply Well 15 To Building Foundation 7 7` To Property Line i t To Disposal Field To Water Main/Service Line R ! To Stream, Pond, Lake, or Major Drainage Course Comments r Page 1 of 2 V� 72-026(11/84) C. ABSORPTION FIELD DATA i u� Soils Rating in Absorption Strata ���� /�� Type of System Design Thee Aj GklFj Date Installed " �% ' �(Jf -P-4/1 Length of Field Width of Field s� Depth of Field Gravel Bed Thickness G r Square Feet of Absorption Area GHQ Standpipes Present -'N) Depression over Field (Y 9 Date of Last Adequacy Test Mck. V /0 -� Results of Last Adequacy Test Separation Distance from Absorption Field To Water -Supply Well - C Z> o To Property Line 30 To Building Foundation :S D �Existing or Abandoned System on Lot It�r��- 1pror_i hr�I 0n A �vi-On Adjoining Lots T To Water Main/Service Line �� To Cutbank (if present) A1 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons — nhole/Access (Y/N) "Pump On" Level "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for ing Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I a e checked, v rified, orconformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 7— v Company MOA No. y Receipt No. �7� �OF A4 Date of Payment ``�� ��� �eL °°° ri ° J� pp J° Amount: $ ld d�{ 6 �i n,(1 er's Seal E!O osue0aoa eaa°fr��eo�a�p9 ° f Lem Raid, Jr Page 2 of 2 72-026 (11/84) M 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS �C Zi ti VrME t G.-�tiA.G TIME TIME - DATE ❑ One ❑ Four ❑ Other DATE DATE ❑ MULTIPLE FAMILY C Three ❑ Six 7. WATER SUPPLY *ATTACH for drilled INSPECTOR WELL LOG. A well log is required all wells INSPECTOR INSPECTOR �a03,hja ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ORAGE ® INDIVIDUAL/ON-SITE** DEPT. OF !'- ALT I & ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL TECTION NOTE: TH� INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 MAY 2 7 1980 ENVIRONMENTAL 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. 1. PROPERTYOWNER PHONE ll 1 l • MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE �j(J 2. BUYER C`_ E PHONE n I i MAILIN ADDRESS L)r g v 3. LEN NG INSTITUTION PHONE MAILING ADDRESS Ci CD3 4. R ALTOR/AGENT /t PHONE r CM MAILING DRESS r eGL7 z5j C1A Q M 5. LEGAL DESCRIPTION V-31 h a7' STR ET LOCATION t G.-�tiA.G 6. TYPE OF RESIDENC NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other 1 SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY C Three ❑ Six 7. WATER SUPPLY *ATTACH for drilled 19 INDIVIDUAL* `��'�'@ WELL LOG. A well log is required all wells ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ® INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: TH� INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 7 70 (R 6179) Pam 0 ^ /.��� I"" ' X 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE O - RESIDENCE L'J SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATEF} SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED - LOG RECEIVED 3. SEMAGE DISPOSAL SYSTEM C NDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED 5774 -- INSTALLER EJ -Septic Tank or ❑ Holding Tank Size: AXW If Tank is homemade give dimensions: SOILS RATING /5Z TYPE OF'//TgqNK t Jt� t%�eJtiL- MANUFACTURER 1'a C TOTALASSORPTION AREA MATERIAL i 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area ewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS It —APPROVED FOR } BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) C DISAPPROVED DATE .�---- BY r j 72-010 (Rev. 6/79) O O K : ir W -jI 0, 4: wl . GO C 0. 10 M. � --- C-4 >: Msa p (ASB G E -JL, P F, E U S.Y, AS- BUILT 1984 CONSTRUCTION oil uj 411 WA IL (Ass) ui 1—v 141 k4rAs fel 45 EAGLE Z RIVER dLi� � ar a 0 0 � --- C-4 >: Msa p (ASB G E -JL, P F, E U S.Y, AS- BUILT 1984 CONSTRUCTION Im 7,W. EM -10 TOr -147.7, vt M 7+7. F roe 740.7 OE70 LOS008" 60 i . . P w# so (ASS) J. /Mv. 7) /.09 (" mv 73 Z. 71 (Ass) 'N. f --,Me. 7S9.2i i'4.16) -707 V. . J #4 V. 7.0 i 75-149 wlfrl- If 4, me) (.4:58) EAGLE RIVE dAug. ** 0,14'ev As- Qui/•f IrirOp 7*+o0 lorco HERCULEW ROE CRYSTALENE'll 411 WA Im 7,W. EM -10 TOr -147.7, vt M 7+7. F roe 740.7 OE70 LOS008" 60 i . . P w# so (ASS) J. /Mv. 7) /.09 (" mv 73 Z. 71 (Ass) 'N. f --,Me. 7S9.2i i'4.16) -707 V. . J #4 V. 7.0 i 75-149 wlfrl- If 4, me) (.4:58) EAGLE RIVE dAug. ** 0,14'ev As- Qui/•f IrirOp 7*+o0 lorco HERCULEW ROE CRYSTALENE'll 1 91 10 9 IGILIS Lff9-61f eM o w s son.a.0 yMoP„ sw I Awa r.r p GG�03 QQ+b( 69 -"m 0•r.r5 i,p Li _ DNIA7AIIM »NINl/VU9N17iiN19N7 311S-330 A. //- S1N3W3nOadWl 8YA3S A8VIINVS s NOIS IAIOBf15 5317153 30711N3H 00 K.? - 00:x? !I ns) t�i' 9S f f0'C 1 Hr s i 'A — -- sY '0 ti Cog W � o � (ItJ�6B� J Li?'r9L �It0r•t •/s01!a' sI GvJr012 "1� 00'4y/ -04.Ys„nv N N 97" dot VIOL Iol <IsvJ H 00'09L Wearn rrJ fC"G IMPFF'M` 'fir It. 1vsYJ ethaG-enrr tj _ � i ��., ' '1 � • f vGp vp a 1 SILL r01 a 4 v • a� LA ws i p0� o e I 2 r p/a14 JPIVPo. 3t (vtYJ-r,qS/_ (vr9/J .z'694.e rn 42 lMS1 7171 r No.71711.9i -•i I D !� �� 1 S l/S7 I I I D 7171.9-�•{ Zm < - I I 3 M E,4 0 n_ (fltYl �b, l \ � ,JAS] )o11'ri:',ol ' _ oL0"L Al (OW)10/ I d..�.v ,-o= � J - 1 ----- f� est \ i 2i'so.IZ — — I .— 9) �o i tfr•s ��,W � /� � �ssalJr/•st...,,1 — � — `(� j 1\ �s.i, •yrs I _ --7/ I 1 cv: 59, _sc_• ss.. .�..1 Q1 N „Lfi,sf0-C h i S� f•T -•I O a/ 1 cfl. I (9SYJ c^o.c nn, ( R� ;Or \ aw s DSY) I o, a -o ; c ,IC -� � roil N �� •+c~r Dow&- i i4070.9 •-07 I - I '= tD IJ o s J i. � i