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Home My WebLink AboutPREUSS #4 BLK 9 LT 5 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 Name DISTANCES Address ~ SEPTIC ABSORPTION TANK FIELD WELL LEGAL DESCRIPTION LOT LINE Lot ~ I Block ~ l Subd'~ ~W G FOUNDATION Tow~shipl Range, Seclion A8-BUILT BIAG~AR (Show Iocahon Gl well, septic system, property hnes, loundahor driveway, water bodies, etc.} ~EPTIC ~ HOLD'NO I' l Gravel length Gravel width Total absorpt,on area D,st .... between hnes X~ / Number of hnes J S°ll rallng Pipe material I ~ I WELLS ' ~.-&~ ~RIVATE ~ OTHER (Identify) ~-'~l Ola~[l~iCat'o'] (A,~,C~ To[al Depth I Cased 1o ~ -- ~ REMARKS: ~ ~m~/[ Eagle River, Alaska9577. .,,. I c~-~ ..... ~ ~,~.. +74'7 o£ ._- I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16- 17 18 19 DEPT. OF HEALTH ~ fDE¢ 2 9 lgR~ Township, Range, Section:/¢/~/ ? /~.//, SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT Depth to Water Atier MonilorJng? Reading Date Gross Net Depth to Net Time Time Water Drop / ¢/hr 4 //n lo ,, i1 ~" i ~" MUNICIPALITY OF ANCHORAGF H~,,~,th and Environmental Prot~ Lion Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL [ INSIDE LENGTH MANUFACTURER INSIDE WIDTH _ MATERIAL ~3,~_~._(~._.. NUMBER OF COMPARTMENTS LIQUID DEPT'H LIQUID CAPACITY\~IOO GALLONS. TILE DRAIN FIELD:· DISTANCE FROM WELL ~NN(~ FOUNDATION ~N~ ~' ~ TOTAL LENGTH . NEAREST LOT LINE N.~ _ OF LINE -~ /{ z cj(2 ~¢~'.'/ ~ of Lines ~.~ DISTANCE BETWEEN LINES TRENCH WIDTH~ IN. TOTAL EFFECTIVE / ABSORPTION AREA ~ ~ (~ ~'SQ. FT. LENGTH OF EACH LINE ' ~'~ DEPTH OF FILTER DEPTI{: TOP OF TILE TO FINISH GRADE.z) MATERIAL BENEATH TILE_""~ ~ IN. ABOVE TILE /~.~. IN. SEEPAGE PIT: Log 'Crib Rings BUILDING FOUNDATION__ DhAMETER __ OR WIDTH Crib Size: DIAMETER___ NEAREST LOT LINE__ CENGTH DEPTH .DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: ~ ~ ~, Installer: ~1~5~$ (~ ~1~, Remarks: F'E~H I T NO. ,' 7:-3E~'; 4,4. ', FI F' F' 1... I C f:I I'..I T L. f"IC:F:IT ]: ON LEGFtL FRED '.SHEEHFIN DF¢,,,'ZE:, L. 5 E:9 F'.F..'_ t:'"_' E:OX 3::.::~!7 EFIGLEt:-I/. ..... .. L.OT S I ZE "f'YF'E OF SOIL FIE'E::F;.'ETION ?.'; 'STEM 15: "f'F.:ENF:H 6; S:.' ,::t. .2"tEtEtEi(:'!I SI'~d_I:ZlI:;;fE F'EET HFt::':;:[HUi"1 I",ILli"IE:EI;i: r3F E:E[:,F.:OCd'T:_.; = 3: SOIL F:I::rTTNC_~ ,::St:.:! FT,--"E:F.:::,= THE F-:Er.:.¢JIF.:EE:, '.::~;Z:._:':E OF: THE SOIL F:IE:SCII:;.:F'TICd'.4 SYSTEM it:S: IF:, E F" T' II.-dl ==- ',' .... L. E-3 ~"..4i ,Z~ -ii- IF-I~ .... __ ,-.-."~, F: !l~ %-" E: IL._ THE LENGTH E:,tHENSIOi'..I 'rS THE LENGTH ,::tN FEET', OF THE TRENC.:H OR E:,RFIINI:--IEL. L":,. THE DEF'TH OF' Ft TF.:EI'.,IC:H ".'~' PIT ]:S THE DISTRI'.,ICE E:ETHEEN THE L:..qJ.P::FF:ICE OF THE C:JF.:OUND 1::II'.4E:, THIE E;OTTOH F'lF THE E,..,~.~ ,HTIUN ,::IN FEET::,. THERE IS i'.4r-~ "-'.;ET I.,.lI[:,"rFI F'OR TRENCHES:,. THE ~ .... ' ' .~F..H,EL [:,EF'TH IL--;, THE HINT. HUH E:,EF'TH OF GF.-:I::f,,,'EL E:ETI4EEN THE ntFf'~::F:iLl F:' '~_" FINE:, THE E:OT"f'CIH OF THE EXCFI',/'FtTION ,::Il'.,! FEET::,. R F'FICI<Fi(XiE PLFIt'.,!-I" HFIY E:E ]~t"~STFtLLE[~, FIT THE F'EF.':I"IlTTEE'"':Z, EIF'"FZCIt",l '_:;LIE:JEC.:T "FL~¢~.THE FCILLOI, I I NG C:OND i T IONS: :.t..E:[THER FI I .... _.Lb_,::, :[ FIF.: If I'.,l~;F FIF'F'F']',,,'EE, F't_F~i'-,ft" I"IFIY E:E INSTFIL!. ED. .,: 2. I:1 CF~NTZI'.,IUOU:E; HF:IINTENI=INC:E FII:~F::EEHENT .]:% F.':EQU]:F:EI::,. F1GF::EEHENT :I::.S NOT KEF'"" E:IIf4'F.'ENT YFIII P'F .... E:E F.'E.':U TRED "Fr'~ I':'NI FIE!%OF.:F'TZON %YSr, TEH Fli'.,IE:,,.."OF.-: YOU MFIY E:E %IJE:JEC:T TO ....... T' ~.-JI ,"'Z, .:_- ;2'~: .":, .~ Ih. Il S; Il::" E~Z C: ""¢"' [E ~L} Ii%It ES.'; FII F:_" E£ BFICKFTLLING OF FINY SYSTEH HITHOLIT FTNFIL ZN'.--.,F'ECT!'Fd'.~ FIND c'~"'~"~"F'""¢ ':4" '"'~?,'" r:,EF'RF..:THEN'F HILL. E:E SUBJEC:T TO F'F.':OS-;EC:LIT]:-.JN I',I~NII',ILIH [::,T:STF:II"4C:E BET!-,.IEEN FI HELL. FIN[::, RNY ON--~ITE S:;EHFp3E E:,TSF'F~'::;FtL.S;'.?iSTEh't'*" I :S . ±EIO FEET FOF:: FI F'F.::[',,,'I::ITE NELL OF.: 26"~E1 FEE"F FOF..: Fl F'tJE~LZC t.,.I~L.L.~ OTHER F.':EQIJ ]: F.:EHENT$ I','IF4Y FII::'F'L_Y. SPEC Z F ]: CFIT 1_' O1'.4'._:; F:INE:, C:C'FlWST~:~.~:T Z L3%L. ibI FfGF:F:II'T:S F:LF.:E FI","R I L-FIE:LE TC, I NS;UF:E' E'F. P3F'EF.: 1:4S'TFiLLFIT I ON. . ~ F" E F':~: ~'"11 Z T E X IF:::" ~ II;--": IE S If:, E C E Ir-'iI E:i, E I~:: ::-Z-": :.1.....? I CERT :[ F"r' THFr'f' ~'%~ ±: I Fd"l, ,FFIHTLI =; ,.liT- T...,E, ~EC-.U]:r4,~HENT':; FnF' '" '.,1-':: ]'TE~.~E,-~''' F-F":~:, RN[", PiE[ [ ':; F~':: 'SET OF- ...... ,/" .... ~.. I I.,.IiLL Ii',ISTFILL THE S"r'L"";TEH ]:N RCI].OF4:E.,I:II'.rlI_:E P.III"H ~FHE CO[.:;E:S. 2:: I UNDF~RS:.,TFII'.,ID THI:IT THE UN-S; I TE SEI.,.IEF: '.SYS;TEM l"~l~ F::Eg LI(~F?E E Nt!F~I,~'Gf.SMr_.:.:NT RES I [:,E/NCE~ REI'.IOI::,ELED TEl I NC:L. LIDE HOF.:E THF1N :!~:>t~2, t~:OEd-,1F..;x¢ ~% :,~__::.,.:: .. RF'F'L I c:Rt'-~'rF'RED '.SHEEHF:IN T'_:;SUE[:, E, ~ .............. [..'1"I f F-_. _. ','";'_:. I~i. DATE ~ Redi~orm ® 4S 469 Poly Parc (50 sets) 4P469 s~No PARTS ~0. $ WITH CARBON ~hnAC~ - PART 3 WILL BE RETURNED WITH REPLY DETACH AND FILE FOR FOLLOW-UP :,, ~C~l(L~ il:l( AN£HURAGE AREA BC~ !UGH Department of Environmental Quality . 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMEJoN" ~****~ MAILING ADDRESS/~ PHONE LOCATION SEPTIC TANK: DISTANCE FROM WELl .MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /O~ GALLONS. SEEPAGE Pit: NUMBER OF PITS I DIAMETER LINING MATERIAL /~¢)~' CRIB SIZE: BUILDING FOUNDATION '~1 NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) F/ ~ SQ. FT. ADDITIONAL ABSORPTION. WELL: TYPE ~)k~. LL;~ 0 BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST ~ NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE · SYSTEM //~ REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL. LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM DATE .~/Z ~V APPROV ..~?z_, /t .~__g4~. /.A.A.B. Russell! Oyster 694-2774 Civil Engineering Soils ~' Foundations 0 ~ E ENGINEERING ~ DEVELO~MEN7' CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 SOIL LOG Earl Ellis 333-5240 Surveying Land Development Performed for: Legal Description: Depth (feet) 0 1 2 4 5 6 7 Mailing Address: ~. ~o× ~ ~'~g-~--~v~ ~\~ Soil Characteristics 10 11 12 Ground water Encountered: Yes Proposed Installation: Seepage Pit~ Comments: ~x C~$_c~t~ No ~/'If yes, what'depth~ v/~Drain Field Performed by: Date: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 050-572-55 HAA# H88-0536A 1. GENERAL INFORMATION (Must be completed pr[or to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 5 Block 9 Preuss Subdivision ~4 Location (address or directions) 20611 David Street (b) Property owner Lynn S./Lauretta .M..Ki~lel~h. one: (home) Mailing Address 20611 David S~reet, Eagle River, Alaska (c) Lending Institution Telephone Business 99577 Mailing Address (d) Real Estate Company and Agent Address Telephone (e) MailtheHAAtothefollowingaddress:(o[checkhere[],ifh°ldf°rpickup') List. contactpersonanddayphonenumberbelow: S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eaqle River, Alaska 99577 TYPE OF RESIDENCE Single-Family~[~:x Number of bedrooms three (3) WATER SUPPLY Individual Well~J~x Community [] Public [] Note: If community w~ll system, must have written confirmation from the State Department of Environmental conservation attesting to th legality and status. SEWAGE DISPOSAL On-site:t~:x P.ublic [] Community [] Holding Tank [] . Note: If community weil system, must have written confirmation from the State Department Of E~nvironmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidationdateshown below, Iverifythat my[nvestigation of th is Health Authority Approval shows that the on-site water s'upply 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, ihe 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 S & S Engineering Telephone 694-2979 Address 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Date Engineer's Seal 6. DHHS APPROVAL Approved for -'~ Approved ~ Disapproved Conditional Terms of Conditional Approval The MunicipalityofAnchorage Department of Health and Human Services (DHHS) issues Health Authority Approval 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 inordertosatisfycertainfederalandstate requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ROBERT A. SHAFER January 8, 1989 CIVIL ENGINEER MUNICIPALITY OF ANCHOP, A(3E 694-2979 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JAf: 'l 0 1989 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOiL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 RECEIVED REFERENCE: Lot 5; Block 9; Pruess Subdivision #4 You issued a conditional Health Authority Approval (HAA) on the residence located on the referenced property dated December 8, 1988. The conditions of that approval requ~.red the absorption area to be upgraded, cleanout~ on the septic tank to be repaired and a second cleanout installed and the w~l casing to be extended. The attached on-site sewage disposal systeminspection report documents the upgrade of the septic system in accordance with permit #880273. This letter verifies that the septic tank cleanouts were repaired and installed and the well casing has been exteded. Re__AA at this time. A~. SHAFER, ~E. 17034 EAGLE RIVER LOOP. SUITE 204, EAGLE RIVER, ALASKA 99577 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 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) 20611 David St (b) Property owner K~'.g ~r~ ~, ¢/ Telephone: (home) LI~ ,.~E~ /~- Mailing Address ~P,[~11 D~.iH R.f'_ F~9¢~ ~....'u~; ,~,,~ ~q577 (c) Lending Institution Telephone Mailing Address Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following addreSS: (or check here ~, if hold for pick up.) List contact person and day phone number below: Ordered by Lori Torres 694-1590 $ & .5 ENGINEI=I~I~ 17034 Eagle R[¥er Loop Roa~ NO, Eagle River, Aiaaka 2. TYPE OF RESIDENCE Single-Family ~] Numb~;~f bedrooms 3. WATER SUPPLY Individual Well [] Community r"l Public [] Note: !.f 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 [] 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 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 th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 Telephone ~ ~//'~S ~ P ~ Address Date S & S ENGINEERING ,~__~_ ~: ....I ,.,,~,- I~,1 k1~,_ ';PA Eagle River, Alaska 99577' Recommend approval with the following conditions: above ground. 1. Extend well casing to a minimum of twelve inches 2. Upgrade leachfield for two more bedrooms. 3. Find and extend septic tank cleanout. Work to be performed no later than July 1, 1989. 6. DHHS APPROVAL Approved for~---'~-'~/'./)oedrooms by ~ ~ Date Approved Disapproved Conditional -~ Terms ofConditionalApproyal ~ ,~, .~~' ' The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval 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 A. WELL DATA Well Classification OF ANCHORAGE (MOA) (~_f,,~!i~U~thority Approval (HAA) CH~'C'KI~t~T - FEB R UARY 1984 343-4744 Well Log Present (Y/~j) t'~ Date Completed Legal Description: ~ ~'~ ~ ~-~ If A, B, C, D.E.C. Approved (Y/N) ~ Vel ~/~ Yield ~.~ ~ Total Depth~'¢¢¢/J¢ Cased to ~o¢"'~ Depth of Grouting Static Water Level '~ ~ ~ Casing Height Above Ground "')~-'¢'"'/. Electrical Wiring in Conduit ¢;P/N) y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~,~ To Nearest Edge of Absorption Field9n Lot To Nearest Public Sewer Line ~/~ To Nearest Sewer Service Line on Lot ~ ~J¢ Pump Set At Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ ; On Adjoining Lots ; On AdjOining Lots T~)'Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~'~r' ~ ~C;~=~r~--~C=:;C-'fr~--~I ; Date Water Sample Test Results _~-_~,~t Comments ~~1~ Date Installed '~ '"/--~'~'"/-'¢~"Size Standpipes (Y/~ '~ h-~ Depression over Tank (Y~ Pumping/Maintenance Contact on File (Y~N~..~ Holding q~ank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Air-tight Caps (Y/N) / No. of Compartments '~ Foundation Cleanout /%Date Last Pumped ~ ; for - Temporary Holding Tank Permit To Building Foundation To Disposal Field To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments -}¥ ~_~-~ ¢~ ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/;~ 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 Comments '~ ~'~'-/~-/"~¢-.¢~ 'Z---¢¢~ Type of System Design~"~"~..~ Length of Field I Depth of Field / Gravel Bed Thickness Statndpipes Present ~2~N) "-./' Date of Last Adequacy Test /'~-- To PropertyVLine To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) r~/,~, I D. LIFT STATION ~ /A High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) uring Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effg. c~the date of this inspection. _ Si ned $ &$ E.NGI, NE. ERI.N,~.,~, g ~ 7034 ~a~,~ .jv3r ---,. Company Ea~leRIver, Alaska $~57~ Date /~ ~PI~. Date of Payment /~- ~' ~ Waiver Fee: $ Amount: $ /'7~,¢~ Date of Payment 7~-o~ (R~v. 7/~) e,c~ Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~,~',;.'o~.~,~.~,'~,~ FEDERAL TAX ID # 02-0040440 M!ALT,SIS RE?O?d? BY 5AI,fPLE flor ~tork O~de~ ~ Date Report ?riY~te~: D~C 5 88 ~ !2:20 Cii~n~ Name : $ & S ENGI~EES1NG Client Aeet: ~iiISEIIGP P.O,~ NONE ~EC'D Ordered ~y : R. $CI{AFER ,IrmiysJs Completed :DEC 1 88 Laboratory fk~pervisor :~]T~PHEN C, SpociM Instruct: Chang:lab [~ef ii: 3598 Lab Stool ID: 3 L~atr!x: IqATER Allowable Parameter Tested. Rosuit/Unit ~ ~.~et hod Limit ~ !~ITREfR-N 0.29 ~ng/1 EPA 353.2 ~0 8c~mple ROUTINE $Ai,IPLE Remarks: ~AI,.'.PLE COLLECTED BY BJS. I Te~ts Performed Soo Spoe~al inetrnotions Above OA=Unavaiiable HA~ lief Analyzed LT:gess Than, GT~Grester Than #1: Time Date Insp 2-2~8 Tuesday Pr a~t~ DEPARTM~_.F OF HEALTH AND ENVIRONME[~L PROTECTION~c>~: 825 L Street, Anchoraa~. Alaska 99501 , - ~ 264-4720 ~ f~L C_~-~ ., Da~e R~ceived: February 23, 1978 ~2: Time ~ [~~ ' ~ ~3: Time ~ ~-[~ Date ~/~[ Date ~ ~-~ Insp ~~ ~ Insp ~~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Would like to hand carry, when finished. 1. Lending Institution Request: Alaska Bank of Commerce Mailing Address: Pouch 7-012 99510 Phone: 279-5641 2. Property Owner: Fred Sheehan Phone: 694-2623 Mailing Address: % Lottie Buscemi/Anchor Realty, 272-8481 3. Legal Description: Lot 5 Block 9 Preuss Subdivision #4 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: o Well System: Permit ~ Construction Individual well (x) Community/Public System ( ) Depth of Well 256' Well Log on File ( ) Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size On-site System (x) Public Utility ( ) Installed 19737 Installer /~7~ Manufacturer Absorption Area ~-/~ Soils Rate Material Distances: Well to Septic ~nk /~/ to Absorption Area to Sewer Line Nearest Lot line to Nearest Lot Line Absorption Area PAge Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block 9 Preuss Subdivision 94 Comments: Affadavit Attached: Approved: ~ Disapproved: Letter Attached: Date: ( ) Department Worksheet: "~¢ MUNICIPALITY OF ANCHORAG'L Department of =ealth and 825'. L Street, ~chorage, Alaska 99501 264-4720 '~equest for Approval of Individual Sewer .and wa~er Facilities 1. Property. Owner, Name of Buyer: Mailing Address Phone: Phone: Lending Institution: Mailing Address: Realtor/Agent: Ma~ling Address: Phone: Legal Description: Street Location: Single Family Residence: Multiple Family Residence: ( ) Water Supply:. *Individual Well If Individual Well, well depth Number of BedroomS, ~ ~o~ ~. Number of Bedrooms: ~) Public/Community System If Community System, name of system 8. Sewage Disposal SYStem: *~Dn-site System ~ Public System ( ) If On-site System, date of installation: /?'7 ~ ~ *NOTE: A well log is required on ALL wells drilled since 6/75. **.If on-site sewer system is over two(2) years old, an adequacy .test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "c" Street, Anchorage, Alaska 99503 274-4561 Date Received '!'.I~,_.~'~' '~,. Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Fc~Fi<~' i<ivc~r Ai:~ 2. Property Owner: Phone: Phone: Mailing Address: 3. Legal Description: 4. Location: Type of facility to be inspected Well Data: No. of bedrooms A. Type ~! ~ C. Construction Sewage Disposal System: A. Installed B. Depth D. Bacterial Analysis B. Installer C. Septic Tank: 1. Size i(!:)C, qa~l'.:~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area !~i~S "'~'~"' %~2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~?ag~.,2 of two pages - Re~ st for Approval of Individual S =,r & Water Facilities Legal Description · ~ Comments Approved~~. ~ ~.~. Disapproved Date 'i~.'~ Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental 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)