HomeMy WebLinkAboutPREUSS #3 BLK 5 LT 2
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number:
Legal Description Property Owner Name & Address
Preuss #3 Block 5 Lot 2 Victor Bailey
10227 George Place Eagle River, AK 99577
Pump Installation Date:
5-20-21
Pump Intake Depth Below Top of Well Casing:
339 feet
Pump manufacturer’s Name:
F&W
Pump Model:
4F07G10301S
Pump Size:
1 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
Unknown
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Unknown
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
n~.~e DISTANCES
AddressFROM~ TANK FIELD WELL
Phone(s) I P~ N°' of Bedrooms WELL
~ 7/ -~[~ t~ LOT LINE
Township, Range, Section
AS-BUILT DIAGRAM (Show I~l well, septic system, properly lines, foundation,
~ /~ ~ ~ / ~ ~C ~ driveway, water bodies, etc.) / %~-
TA.KS
Material No. of CompaAments
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER - e,~ ~-A~:A~
Depth ,o pipe bottom from Total depth from odgina, grade ~,.,~. ...........
original grade FT FT
Fill added above original grade Gravel depth beneath pipe ~ ~ ~ ~ , . , O ~ I
FT FT
Total absorption area Distance between lines
SQ FT FT
SQ FT
WELLS
~ PRIVATE ~,~r,~ ~ OTHER ildentifv)
Clarification {A,~,G) Total Deplh FT G~d to ~T I
REMARKS: ~w~ ~ ~ ~ Tz~ ~N ~
'eagle mverp. O. Engineeringgux ;;32~ Se~ices
I cedily that this inspe~i0n was ped0rmed according to all
Municipal and Slate guidelines in ellect~ date: ~/~ ~/~
Health Depadment Approval [/
72-013 (3/85)
I'1 U I',t I C I F:' A I .... I T Y O I:::' A N C I'"t 0 R A G E
:C, ep~:~rtmerrL c),f' Ple.'-alth & Human
O I',1 - S .T. 'T E S E I::> T I C '1" A N K P E R VI I T
Dat.~ Issued: OE:~ '~"/88
E n :I. a p g e m e n C
O~tne'r' Name." I-'1,, U. D,,
C]~^~nep Addr'ess~ 7():1 C ST BOX 6/]-
ANCHORAGI:, Al< 995:1.3
-4665
Par c:e 1 ]: d: C>5()-5'71.-:37
Lot l....egal~ Subd:i. vi:--sion," PREUSS Lot." 2 Block: 5
Sectic, n: 8 'To,reship: 141',1 Fi'.ange~ ~W
I_ot S:i. ze 2.2890 (sq. t't.. oF ac::pes)
Max ~G~dpooms~ This F'E.)pl~i'L~ 4 'l"o'Lai Capacity: 4
SEF'TIC 'TANK~', Minimum-Lotal septic: 'Lank c..<%p<~,...:ty, t,,.--' .... gallons,, Eac::l': sept:i.c
Cank mus'L ha:ye at :l. eas'L :~,~: comp~rtmen/s. De. ptl-~ '(.o top oC s~pt±c Car"~k(s) < 4,,()
,c~ .... f'HIS PERMIT
REPL~C;E EX ~. ,~ f l NG ]"ANI< TO. AL. LON FOIJF~ ,_~:~t:'r~::,_,¢, ,u~..nr]lvlc~, ,,. ,,
ISSUED I::'C~R A SIN(aLE FAMILY :[:)IAIEL.L. ING ONLY AND EXF:'iRES :1.2/~!1/88,,
NOTIF:Y DHHS PRIOR 'TO :[ IqC~F'ECT ]: ON,
I CEI::(I" ]: F:Y THAT
~.. I am t'am:i, liar w:i. th 'Lhe: pequipemen'Ls ~'or on.-.si'Le sewers ar'id we:J.].s as set
eot'Lb,by 'Lhe Munic::i.!:~lity
i::,, ]: ~z.~:J.].l :i.n~:ia!Z the sy::teni in ac::cordance ~,g:J.'t.h all f'!C)~ c:ode: and regulatiort~,
ar'icl in c::i::)mpliarl(:e ~]J.'Lh f..!:[:.~ d~:J. gn cr.:~.ter':La of' CI]:L: perm:i.'k,
:::;,, ]: ~,]i].]. adhere to all MOA alUd State o~' Alaska rE,(:]L~:LP(:)flJ[,~FiCS f'(::)i" t:.he set back
[J :J.:~:.al'lC:G~. [ rom any ex isting wel 1, wastewatep disposal system or pub 1 ic
:::(::~(.:~PagE, :::y:::t.e:~'l on 'ILl'lis op any adjacent or nearl::)y lcd'...
4,, Z urldepstar'Jcl Chat tlnis permit :i.s raj. id ~'or a max:i, mum o[' 4 bedrooms. ]:
also under'st, arH::l thai', thE, c::apac:i'Ly
any en].arg~:,mer'it ~:i.].]. requ:i, re an additional permit=
:[ s;su~d By ~ ~ I}A'['E:
EAGLE RIVER ENGINEERING SERVICES
'' P.O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
IVJJ®ZTL ®
LETTER
SIGNEO~
[] Please reply [] No reply necessary
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
SHEET NO. / OF
CALCULATED BY /-' ~ ff DATE
CHECKED BY. DATE
SCALE //~ j~ /
SPEOIFIOATIONS FOR ON-SITE SEPTIC SYSTEM
L. EGAL~, LOT 2.., BLOCK 5, PRUESS SUBDZV]:SZON
GENERAL 1. The well and septic plan are for a single family residence only.
2. Ti~e drawing and or site plan shall be a part of this specific)etlon.
5. All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Conservation require~-
merits.
TANK
1.
2.
Existing tank is to be pumped, crushed and filled with sand and gravel
Replaoement tank is to be 1250 gallon~ 2 ooml~artrnent, steel tank
approved by M.O.A.
Replaoement tank is to be set level on oompaoted material.
Clean out between tank and pit.
Lines from house te tank and tank to pit to be snaked.
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOC^T,ON LEGALDESCR,PT,ON
SEPTIC TANK:
DISTANCE i0~!
EROM WELl.
INSIDE LENGTH
MANUFACTURER Hg~f¢ f/~/'¢/4
INSIDE WIDTH
MATERIAL
NUMBER OF
COMPARTMENTS /
LIQUID DEPTH
LIQUID CAPACITY /0~O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER /~"-OR WIDTH LENGTH 2"~'* DEPTH
LINING MATERIAL v-,.,~,~ CRIB SIZE: DIAMETER DEPTH DISTANCE FROM:
TOTAL EFFECTIVE
BUILDING FOUNDATION___ NEAREST LOT LINE__
WELL / ~ for/
ABSORPTION AREA (WALL AREA) ¢~J/~' SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE J~;//'~ CONSTRUCTION ~~¢ DEPT,
BUILDING ~-7~NEAREST NEAREST SEPTIC
FOUNDATION , LOT LINE SEWER LINE TANK
CESSPOOl
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE /~
SYSTEM .
DISTANCES:
INSTALLED BY:
PIPE MATERIAl · '
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE ~/~ //¢7~ APPROVED/~ ~
· ~,~.A.A.B.
NAME OF APPLICANT
GREATER ANCHORAge AREA BOROL~Gh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
pERMiT NO.
PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH ~
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
TOBE,NSTALLEDB X
, OTHER
NOTE: THIS PERMIT 15 NOT VALID WITHOUT BOIL TEST
FINAL INSPECTION: 2~ HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, RE~/UIREMENT5
FOUNDATION tO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit ~) ~ , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL '"/2-/
SEPTIC TANK , SEEPAGEPIT , DRAIN FIELD
TO NEAREST LOT LINE.
1oo BEEPAGE PiT f
WELL TO SEPTIC TANK
DRAIN FIELD ALSO CONSIDER AREA WELLS.
/
DIAGRAM OF SYSTEM
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, - SEEPAGE PIT
TO RIVER, LAKE STREAM.
, SEEPAGE PIT
/0~) t, DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET I D 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.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAl QUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
H~ -* ,' I~
Performed For ]~
Legal Description: Lot
Case #
This Form Reports Soils Log X
~)~)~e~ Dated Performed ~- 2- 7~
~ Block ~ Subdivision_~u~C-mr~__
Percolation Test
Soil Test Must Be Logged To 4' Below Proposed Seepage System -
Depth
Feet
Soil Characteristics
Was Ground Water Encountered?
If Yes, At What Depth?
! I i I J
_J__J_J ~ J
Reading
Date
Gross Time ~ Net Time '
Depth to H2~
Net Oro
.1
Percolation Rate Minu'~e
Proposed Installation: See?age Pit Drain Field
Depth of Inlet ...................... Depth to Bottom of Pit Or Trench'
COMF~ENTS:
Test Performed BY
Date Certified BY:
Da i:e:
$7
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES ,
OF ON-SITE SEWER AND WATER FACILITY
264-4744
8/30/88
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Preuss Sub. Lot 2 Block 5 4~ T14N, R1W, Sec.8
Location (address or directions)
E.R. Lane, Rt on David, Lt on George, Last d~. on ~c.
(b) Property Owner As$cc3-a~ed Dz-ok~z-s- ~ne:~ ~ ~ ~ Business 563-3333
Mailing Address ~ · -
(c) Lending Institution N/A. ~I ~ %~.0 ~ el e ~O/~ ~
(d)
Mailing Address
N/A
Real Estate Company and Agent
Address
Telephone
Mail the HAA to the followina addiess: or: Check here I-I, if hold for pick up.
List contact person and day phone number below.
Pick-up by engineer
(e)
2. TYPE OF RESIDENCE
Single-Family []
4
Number of Bedrooms
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.
SEWAGE DISPOSAL
Onsite [] Public [] 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 1 of 2
72-025 fRev 8/861 Front
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 Firm Eaqle River Enqineering Services Telephone 694-5195
Address P.O.B. 773294 Eaqle River, Alaska 99577
DHHS APPROVAL ~_~
Approved for ¢ bedrooms by ! ~ Date
App~oYed X Disapproved Conditional
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2 72-025 fRev 8,861 8ack
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-472O
Legal Description:
WELL DATA
Well Classification /¢2/¢/~"eTz¢- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ¢~/f~e¢~ Date Completed /~'.~3 ~-,/-. Yield
Total Depth '~/'/~ / Cased to ~zT'o" Depth of Grouting
Static Water Level ~'¢/~"
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot '/~//
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole ~_/'4
Water Sample Collected by
j/
k'
Pump Set At -F .~' ~-¢
Sanitary Seal on Casing (Y/N) /v
Depression Around Wellhead (Y/N)
Water Sample Test Results
; On Adjoining Lots
~/~o · ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Mainte,nance 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 ~//4
Size ,//'¢-~.,~-z~ No. of Compartments
Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Date Last Pumped
~_.//~ ;fOr
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
comments
Page 1 of 2
72-026¢1/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well "¢',/¢;'¢ /
To Building Foundation
Lot
To Water Main/Service Line ¢'/¢ /
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field '
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line / ~ /'
To Existing or Abandoned System on
; On Adjoining Lots -/~ -~,~ /
To Cutbank (if present) ~.~--/~"
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Y~'~----~'~ Date
Company Eagle River En0lneerin! Services MOA No.
P. O. ,ox 773294 g~aC/
Receipt No. Eagle River, AK 99577 c~
Date of Payment ,~/~ ~/
Amount: $ /" ~)d ¢0
Page 2 of 2
72~026 (11/84)
~ MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONE~ENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORIVIATION
(a) Legal Description (include lot, block, subdivision, section, towns~_,, range)
Location (address or directions)
(b) Applicant Name .-~'~ ~c.~-~¢,~,~, Telephone: Home %""f,¢~ * ~/~ Business
Applicant Address q~ ~, ~:~'"~-- %',~1'1"¢~,. ~.-. ~ ,/~"~,J,~4-'L4'', ~ ¢5~Z~,
(c) Applicant is (check one): Lending Institution []; Owner/builder,~--Buyer []; Other [] (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
~one
(f)
M~%the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms '~
Other
WATER SUPPLY
Individual Well,J~: 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 {11/84)
Page 1 of 2
ENGINEERING FIRI~ PROVIDINr~NSPECTIONS, TESTS, FILE SEARCH, DA~-~AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th~s Hca~th
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and
for the number of bedrooms and type of structure indicated herein. I fudher 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
~ 8n~ ~,
Address , k;~,~L~ ~:~[VE~:
Date .............. :';=- '-
Approved fo~' (~/'~;~ bedrooms by_ ~--h?~ ate
¢/~,/ Disapproved - Conditional
Approved
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 of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 {1 t/84)
WELL DATA
Well Classification
Well Log Present (W:~/~
Total Depth '~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit ~/N)
Separation Distances from Well:
To Septic/t4efffi'n'g Tank on Lot
MUNICIPALITY OF ANCHORAGE (M6"~7
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
Cased to z-~C° I ~
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ,~'~, [ct~, Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing~.'~/N)
Depression Around Wellhead (Y,~I))
DEPT. OF HEALTH
ENVIP, ONMENTAL P2OTECTIOFI
E£E VED
; On Adjoining Lots
To Nearest Edge of Absorption Fiel~o/~Lot ~'~J¢~ ; On Adjoining Lots t_.
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole f,~/t~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~t ~ ~ t,,.-) ,~r~:C_J.¢,-.~ ; Date ~ ~ ~
Water Sample Test Results
Comments ~ t.ft~,Ck-~__~ ~ L_.,c'~d_/.~r~.~ ~ ~ ~ . ,~ ",¢~¢I~0~
B. SEPTIC/.~;~L--D11~3i TANK DATA
Date Installed q "1{~-9~
Standpipes~;~N) Air-tight Caps ((~N)
Depression over Tank (Y,~
Pumping/Maintenance Gontract on File (Y/N)~/.~
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/.l=~c~q+~Tankl
Size [~ NO. of Compartments \
Foundation Cleanout (Y/~_
~/~ Date Last Pumped ~.O--'~ ~'E~'
; for ....
Temporary Holding Tank Permit (Y/N) ¢"~/,A
To Water-Supply Well I o"2.~'
To Property Line ~. c:~ ~ J¢
To Water Main/Service Lithe ~
Course I,~ /~.
!
To Building Foundation
TO Disposal Field \~-~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ ~ [ ~ t--'/'~
Width of Field ~'
Square Feet of Absorption Area
Depression over Field (Y/~P.
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well l ~Z-~'I
'~-¢--~'=¢' }P-~CL.~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present. N)
Date of Last Adequacy Test I, ~ - Lo - ~___~-~'
To Property Line b~-~ I',.~
To Building Foundation
Lot h~/
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots ~ ~'")'
To C~utbank (if present)
Comments
D. LIFT STATION
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)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA a~d HAA guidelines in effect on the date of this inspection.
Signed ....... ,~,'~it'l~ Date
Date of Payment ~ "/~/-
Amount: $
Page 2 of 2
72-026 (11/84)
GREATER ANCHORAGE AREA BOROUGH
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received May 5, 1976
Time of Inspection~
Date of Inspection ~o~.
REQUEST FOR APPROVAL OF /~J~.
INDIVIDUAL SEWER & WATER FACILITIES
FOR
cony.
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Executive Realty % Jackie Dahl
2810 C Street
James Garoutte
Box 798, Eagle River 99577
Phone: 276-777
Phone: 694-9777
3. Legal Description: Lot ~Block 5 Preuss Sbdvn
4. Location: George Road
5. Type of facility to be inspected
6. Well Data:
A. Type Individual
Single Family
B. Depth
C. Construction ~}0~ ~
Sewage Disposal System: On-s±te system
A. Installed /'~
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
No. of bedrooms 4
D. Bacterial Analysis
300'
B. Installer
2. Manufacturer
2. Material
, Absorption area
Other contamination
, Absorption area
, Sewer Lines __
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - R~ 2st for Approval of Individual ~,er & Water Facilities
[e§al Description Lot 21 Block 5 Preuss Subdivision
Comments
Approved ,~'~).)~.~.~j_~ Disapproved Date .~--/"~'-~, .~
^pprov alid for one year from date signed
Greater Anchorage Area Borough, Department of [nvironmental Quality
DIAGRAM OF SYSTEM
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)
MUNICIPALITY OF ANCHORAGE is:::,; .'::.~' ~.:: ~ ,;,
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIOi~:':~;!':~i'~'':;. ':i'''L .... ;'
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES :!~ i~ ~' i' ! \i i' j~
I"~, ~ ~' ~ -! ~' ~
1. Type of Inspection: CMRO__VA
2. Property Owner: ,~¢ ~'~ ~- <;
Mailing Address: _ ,
3. Name of Buyer: ~-~
Mailing Address:
4. Name of Lending Institution:
o
FHA CONV ;~
Mailing Address:
Name of Realtor or Agent:
Mailing Address:
Day Phone:
6. Legal Description:
Location:
Phone:
Phone:'
No. Bdrms. ~.
Type of Facility to be Inspected:
Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
Individual
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
If Individual, date of installation
Individual (on-site) ,-~/~'c~
72-003(3/76)
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 4/9/74
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony
Jesse E. Wooten
_ Anyti me
4/10/74
P.O. Box 663 Eaqle River
SAME
Phone:
Phone:
694-2716
Legal Description: Lot 2, Block 5 Preuss Sub _
Location: Right On George Place on 2nd lot from N end on F~t s~de nC ~=
Type of facility to be inspected Single No. of bedrooms 4
Well Data:
A. Type Drilled
C. Construction Standard
Sewage Disposal System:
A. Installed 1973
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
B. Depth 350'
D. Bacterial Analysis
B. Installer Hamilton
Size lO00 Gals 2. Manufacturer Hamilton
Absorption Area 2. Material Concrete
102', Absorption area
, Other contamination
, Absorption area
124' , Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
,Page'2 of two pages - Re~§t for Approval of Individual s:r~er & Water Facilities
Legal Description
Comments
Approved~~ ~.~--4~ Disapproved Date ~//~7/7~/]
Approval Valid for one year from date signed
Greater Anchorage Area 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
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
Street, Anchorage, Alaska 99503 274-4561
9a~e Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
I. Approval requested by:
Mailing Address:/~,
2. Property
___~Mailing Address:
3.
Phone:
5. Type of facility to be inspected w_~__~.~-'~. No. of bedrooms
6.
Well Data:
A. Type
C Construct
Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Seepage Pit: 1.
B. Depth ~_~ ~
D. Bacterial Analysis
B. Installer
Absorption Area 2. Mater~al
E. Disposal Field: Total length of lines
o
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
C. Absorption area to nearest lot line
Sewer Lines
Absorption area
~Q-Oo-= (1174) Page ! o-F t'no n.,-.(m~