HomeMy WebLinkAboutHUFFMAN #1 BLK 3 LT 6L y lk wlk
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v%k
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Rood
P.O. Box 196650
Markeegich Anchorage, AK 99507
Mayor Ww .muni.ora/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue: _
Parcel Identification Number:
Legal Description
Property Owner Name & Address:
H U FFM AN 9'
syre^r
152on
a - 3 L- LiG
Pump Installation Date: 6 -ZZ —15 -
Pump Intake Depth Below Top of Well Casing: l/L)feet
Pump Manufacturer's Name:
Pump Model: Chi a S /
Pump Size 31 hp
Pitless Adapter Burial Depth: %0 feet
Pitless Adapter Manufacturer's Name: 0141MARS„J
Pitless Adapter Installer: N A
Well Disinfected Upon Completion?Yes =J No
Method of Disinfection:
(��Cvbrn�
Comments:
Pump Installer Name: �A%t efrEoa��Jf/C��
Attention: The pump installer shall provide a pump instalhttiln log to the DSD within 30 days of pump installation.
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S\)4 PID Number:
Name: �_Z!s si� izc- t4 Wastewater System: 0 New Upgrade
Address: ZA ABSORPTION FIELD
Phone:
W. of Bedrooms:
Deep Trench OShallow Trench 013ed ElMound 00ther
j
LEGAL DESCRIPTION Soil Rating:
() ltX
Total Depth from original grade:
% GPD/Sq. Ft.
I ?_
Lot: Block: Subdivision: Depth to pipe bottom from original grade:
*
Gravel depth beneath pipe
IAAI�l J- -3 Ft.
Ft,
Township:
Section: Fill added above original grade:
3
Gravel length:
-r) Ft.
Ft.
0 New 0 Upgrade Gravel width:
3
Numberoflines:
Distance between lines:
Ft.
L
Ft.
Classification (Private, A,B,C):
-At
Total Depth:
Cased To: Total absorption area:
Pipe material:
� C6 U -N C i t
Ft.
Ft. SQ. Ft.
ASJN�A
Driller:
Date Drilled:
Static Water Level: Installer:
Date installed:
Ft.
Yield:
Pump Set at: --4Casing
Height Above Ground:
TANK
GPM_1
Ft. I
Ft.
SEPARATION DIST ANCE!!� A Septic 0 Holding 0 S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private Manufacturer:
Capacity in gallons:
From —
Tank
Field
Station
Tank
Sewer Lines
11,5()0
Well-
()0j
Material:
Number of Compartments:
Surface
Water
LIFT STATION
Lot
Size in gallons:
Line
2 -
Foundation
i
t
"Pump on" level at:
"Pump o el at:
High water alarm at:
Curtain Pump Make & Model Electrical Inspections performed b
Drain )ra'
Remarks L-A,-37e^C- � BENCH MARK
Location and Description:
fT/0"M L S P iC IL F 0 A I— 'T IV,4 ri
PROVI t)#_6 /f 1-'t: --a S 1 0 �9_
Assumed Elevation: 1 10(3/ FL
56voTIC- 7-4,JK 13�YCj<tke
", .............
3 E1711311ME0 it Huy
17034 Eagle River Loop Road, No. 204 7�
f,
Inspections performed by: Eagle Rivers Alaska 99577 _72
Dates:
A.,k,
I 0 s T
, %, S, C. COWAN
2nd "$i V,
. �
1 8801
D < epart ment of Health and Human Services approval
Reviewed and approved by: ��Ot,-t Date: 0 0
'a
2-013 (Rev. 9/91) MOA 25
PERMIT NO. SW990392
PAGE 2 OF 3
municipalit •f nchorar_�CD
IALTO A HUKAN SERVICES
DEPARTMENT OF HE H AND
ENVIRONMENTAL SERVICES DIVISION
P.0, Box 196650 Anchorage, ALaska 99519-6650
OTegt�hone: 343-4744
N-SITE WASTEWATER DISPOSAL SYSTEM AND/OR LL INSPECTION REPORT
LEGAL LOT 6. BLOCK 3. HUFFMAN 41
OLD SEPTIC TANK
(ABANDONED)
100,
A,
V
DEVELOPED
SCALE 1" = 30'
F
YUS
WE
a
DO
CO
Co TI MT2
C
_FC0
AD,D/% OA4
/V I
P.I.D. NO. 018-161-17
NEW
TRENCH
FLOW SPUTTER
A
TH#1
SPj DBL2
DBL1 4
00 4> NEW 1500 GALLON
SEPTIC TANK
o T2
TH#2
EVELOPED�
FA
E0
Z
ROBERT C. COWAN
CEl- 8801
PERMIT NO. SW990392
PAGE 3 OF 3
MunicipaUt •f nchorane
lk HU
DEPARTMENT OF HE TH AND KAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, A(aska 99519-6650 Tegl�hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR LL INSPECTION REPORT
LEGAL LOT 6, BLOCK 3, HUFFMAN #1
nINAL GRADE
MTI Co1
CO2 cot = 93.1'
11 ,-'-0O2 = 97.0'
P.I.D. NO. 018-161-17
NEW
92.4 1500 GAL �92,2'
SEPTIC
TANK
MT1 = 81.5'
SCALE = N.T.S.
C01 = 90.2'
CO2 = 90.3'
A
NO WATER FOUND
75.5' B.O.H.
A
Q
FC01
2 2.0'
8. 0'
_ST 1
21 .0'
49.0'
_ST2
22.5'
46.0'
_DQL1
25.5'
45.5'
_D B L2
26.0'
45.0'
C01
62.5'
60.5'
_HT1
48.0'
26.0'
_CO2
48.0'
26.0'
MT2
30.0'
35.5'
-------------- 4--------
SCALE = N.T.S.
C01 = 90.2'
CO2 = 90.3'
A
NO WATER FOUND
75.5' B.O.H.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW990392
Legal Description: HUFFMAN #1 BLK 3 LT 6
Design Engineer: 0003 S & S Engineering
Owner Name: Les Syren
Owner Address: PO Box 112141
ANCHORAGE, AK 99511-0000
qLC LACL ,-
Date Issued: Oct 19, 1999
Expiration Date: Oct 18, 2000
Parcel ID: 018-161-17
Site Address: 013800 SPECKING AVE
Lot Size: 17424 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 2
This permit is for the construction of:
❑✓ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
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
(907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
AT THE TIME OF CONSTRUCTION, ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST
ADEQUATELY DEEP TO ACCOMODATE THE TOTAL DEPTH OF THE ALTERNATE SITE AT THE SOUTH END.
Received By:
Issued By:
Date: /012 ef�
Date: /0 — /
October 19, 1999
Robert C Cowan, PE
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 6 Block') Huffman Subdivision 91
Waiver Request #WR990082
Parcel ID 9018-161-17
Se990392
Dear Mr. Cowan:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
0.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel I Roth
Civil Engineer
On -Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR990082 PID# 018-161-17 HA#
Date Received: October 6, 1999
Legal Description: Lot 6 Block 3 Huffman #1
Engineer: Robert C Cowan, PE, S & S Engineering
Permit # SW990392
17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577
Applicant: Les Syren
Waiver Requested: Lot line waiver of 0 feet from the property line to the trench
separation between the proposed trench & existing crib of 10 feet instead of 18 feet.
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: x Waiver is NOT Granted:
List Conditions or Reasons for above: SEE FA e i.,Fcra' t 7Tp ti1FL Epi
Date: /0 —lq—y9 By: AJAI
Name of Reviewer
Rec # • 05334/0170 Amount: $ 115.00 Date Paid: Oct 6, 1999
October 5, 1999
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTHAUTHORITY
MLJNICIPALITY OF ANCHORAGE
APPROVALS
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
SEWER &WATER
MAIN EXTENSIONS
REFERENCE: Lot 6, Block 3, Huffman S/D #1
SEWER&WATER
It is requested that you issue a permit to install a septic system to serve the proposed
INSPECTION
rive bedroom (existing -f wo bedroom) dwelling on the referenced property. The
existing two bedroom crib will remain in place and an additional three bedroom
trench is proposed for installation. An alternate site for a future rive bedroom septic
ENGINEERING STUDIES
system is shown on the attached site plan. A zero foot lot line waiver is requested for the
AND REPORTS
trench, and the separation between the proposed trench and the existing crib is requested to
be waived to ten feet (18 feet normally required).
WELLINSPECTION
& FLOW TEST
Two test holes were excavated and percolation tests were performed. The approximate
location of the test holes are located on the attached site plan. At the time of excavation
9/29/99 water was not found. After seven days of ground water monitoring the tubes were
SITE PLANS
found to be dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
ROAD DESIGN
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
SOIL TEST
If you require additional information, please contact us.
Sincerely,
PERCOLATION
TEST
Robert C. Cowan, P.E.
STRUCTURAL &
MECHANICAL
RCC/jhm
INSPECTIONS
Enclosure
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: S YR 6 il DATE PERF
LEGAL DESCRIPTION: k t 13LOct< Township, Range, Section:
DEPTH
(FEET)
3c. -
4-
14� Lf-
5lif 1' `j 1.
?l #
6
7 -
8-
9
10
Wel
411
COMMENTS
SLOPE
/env a-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT L0
DEPTH?
Depth to Water After
Monitoring? Date: w-fi F
f,- I 1-
.V.� .. ........... ..
SITE PLAN
I=
Ina
mom
INN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
12
13-
ho Al
-
-7
14-
16-
17 -
18
43 61,14
Wel
411
COMMENTS
SLOPE
/env a-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT L0
DEPTH?
Depth to Water After
Monitoring? Date: w-fi F
f,- I 1-
.V.� .. ........... ..
SITE PLAN
I=
Ina
mom
INN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
ho Al
-
-7
'3
V
j4 0
-7
010,
PERCOLATION RATE t� 7 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 6 FT AND 7 FT
S & S ENIGINTEERINGI :2L 2/Z
PERFORMED BY:ZL/l CERTIFY THAT TH S TEST WAS PERFORMED IN
I -
1704-4 eagle RKIVUg 1 o. 2e4
ACCORDANCE 4111018:1)WA104WIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: LL- � y -Y /Z eq ,.,/
DATE PERFORMEb
LEGAL DESCRIPTION)"c 7- 6 3L ,, -c,< 3 14,P,1tj1jv 4 hownship, Range, Section:
10- WAS GROUND WATER
ENCOUNTERED?
11 s
IF YES, AT WHAT L0
12- DEPTH? p
E
Depth to Water After
42
13 - Monitoring? Date:
14-
15-
16 -
17
18
ig
ROSEIV C. COWAN
SITE PLAN
ME
MM
me
Reading Date
DEPTH
Depth to Net
Water Drop
SLOPE
0--
(FEET
A6-fits
0
f4
14-r 6-Z
3
0
4-
5
6
7-
8-
5-A Oi L
9-
10- WAS GROUND WATER
ENCOUNTERED?
11 s
IF YES, AT WHAT L0
12- DEPTH? p
E
Depth to Water After
42
13 - Monitoring? Date:
14-
15-
16 -
17
18
ig
ROSEIV C. COWAN
SITE PLAN
ME
MM
me
Reading Date
Gross Net
Time Time
Depth to Net
Water Drop
0--
0
f4
20 PERCOLATION RATE 30
TEST RUN BETWEEN 6 -
COMMENTS
(minutes/inch) PERC HOLE DIAMETER
FT AND '7 FT
S & S ENGINEERING
PERFORMED BY70-34 �agle RiyeF Leep RGad No -204—I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE FWWAqY'e§T&5)R9ZVt?1CI PAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
GAA B -"D -I = GRF&TER ANCHORAGE AREA BOROU0H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME ZVCZZ�,Z� � �� ADDRESS
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY GALLONS
SEEPAGE SYSTEM: SEEPAGE PIT:
Loi" G
PHONE_5141 '
NUMBER OF
ATERIAL �� L1/✓✓'� COMPARTMENTS
S;s�//✓tea %� �/f %G�� LIQUID
INSIDE LENGTH t-� INSIDE WIDTH f® DEPTH
NUMBER OF PITS OUTSIDE DIAMETER -OR WIDTH +Za`y , , LENGTH /DEPTH '
LINING MATERIAL U G- DISTANCE FROM WELL rBUILDING FOUNDATION 2-e f
NEAREST LOT LINE. -y / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) �7�9 SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATI
NUMBER OF LINA DISTANCE BETWEEN LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
LENGTH OFir AACH LI
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:DISTANCE
TYPE ���/�
DEPTH 150 f
FROM WATER
BUILDING FOUNDATION. SAMPLE ✓"
NEAREST
J ✓ NEARESTSEPTIC
0
',TANK
i SEEPAGEc ," .--
3 ,S!CESSPOOL
OTHER
SOURCES_
LOT LINE / SEWER LINE
� SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
DATE � / APPROVED
Nceiru eiirNnaiiv
GAAB-HD2 J GREATEN ANCHORAGE AREA ^)ROUGH Case No.. x
HEALTH DEPARTMENT
r... 327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM – APPLICATION & PERMIT
NAME OF APPLICANT "`&u4z�MAILING ADDRESS PHONE NO.jZ- eOIF6
RESIDENCE ADDRESS LOCA I N OF INSTALLATION—
RESIDENCE /
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK, SEEPAGE PIT /� pDRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY ��� �'"Z.
FINANCED THROUGH TO BE INSTALLED BY
" ANTICIPATED DATE OF COMPLETION
PFE�c+A En rlroT�EST RESULTS
'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
DISTANCES:
ro
.PAP
HEALTH AUTHORITY
OR
DIAGRAM
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LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.` eQ- / `s
LIM-
nATF9/ 0 , c l 7v APPLICANTS SIGNATURE �Au
�,REATER ANCHORAGE AREA BOROUGH �\
HEALTH DEPARTMENT CASE �!
327 EAGLE STREET
" ANCHORAGE, ALASKA 99501
Performed Forte/// k"6L �c� < < _ Date Performed
Legal Descri tson: Lot Black Suhdi�=i.sion ,�/��
g P 'fie ""�"`a�"�"
This Form Reports a: Sai s Log .-Percolation test`
Depth
Feet Soil Characteristics
711Q sPr//inerifr a�
1?
IN
S-4 Gr»
. ........�,
Was Ground Water Encountered?
0
If Yes, At What Depth
Location Sketch
Reading Date Gross Time Net Time Depth To H2O Net Drop
,.......,°...,....
Percol, Minute »
Proposed Installati on Seepage Pit Drain Field
Depth Of Inlet a'- y t)epth To Bottom Of Pit Or Tr=ench �r
COMMENTS : /C' 11, I- _/ .I- _ Y3 71 y
Test Performed
Data Certified
Date:/4 A
G
5. LEGAL DESCRIPTION
DATE'RECEIVED
INSPECTION APPOINTMENTS
P
TIME
TIME -
TIME
DATE
DATE ;l' I
DATE
hVj
u-Iu'SID
INSPECTOR
INSPECTOR
INSPECTOR
7. WATER SVOLY
MUNICIPALITY
&
MUNICIPALITY OF ANCHORAGE
DEPT. OF I'':^.LTiI
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE@"PWOiViv1EPJ1;gL P:•`-'('CTION
825 L Street - Anchorage, Alaska 99501
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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
i, ✓�
PHONE
3 u 4l - L -I �t 2
1q ev
MAILING ADDRE
✓ZP i0oX (77,07LAJ
PROPERTY RESIDENT (If different from above)
PHONE
1A L>F M A ti I L_cv T L K
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
A(_14sA-64 t�4�u 7/i f O� r�a2TtF
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
( ) nJ 6-A
Y41_ f7
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
v,EcKIP (�,:- AD
6. TYPE OF RES[ ENCE
NUMBER OF,BEDROOMS
E]E]Four ED Other
SINGLE FAMILY
S2'' Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SVOLY
-
INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
IGI�Z_YEAR
C� INDIVIDUAL/ON-SITE**
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
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE
❑ TWO
❑ THREE ❑ FIVE ❑ OTHER
❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
EJ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septi Tank or ❑ Holding Tank
Size: 6706 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
` t
4. DISTANCES
WELLTO:
Septic/Holding Tank
SSl
Absl/orrptiti�on Area
%S r
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
LAY APPROVED FOR --- BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
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GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
�GAO£P£0 ,A00.4Y „°e, 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received June 23, 1976
Time of Inspection 2:30 p.m.
Date of Inspection 6-23-76 Les
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: First National Bank of Anchorage
Mailing Address: Post Office Box 4-2090, 99510 Phone:
2. Property Owner: Norma J. Coleman Phone: 344-3078
Mailing Address: Star Route A Box 217, 99507
3. Legal Description: Lot 6 Block 3 Huffman Subdivision #1
4. Location: See map on back
5. Type of facility to be inspected Single Family No. of bedrooms 2
6, Well Data: Individual
A. Type _ B. Depth 150'
C. Construction ,�.ti�� D. Bacterial Analysis 4YI126 k4.
7. Sewage Disposal System: On—site system C60-Ld-
A. Installed 1970 B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 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
FO -034 (1/74) Paae 1 of two oaaes
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO—VA—FHA —CONY
2. Property Owner:
Mailing Address: SP P 'q�l Day Phone: IJA JJ 'S
3. Name of Buyer: r^A_-s �j
Mailing Address: Day Phone:
4. Name of Lending Institution:
Mailing Address:o2C) I Phone:% Le U,,
A
.1
7
Name of Realtor or Agent:
Mailing Address: Phone:
Legal Description:
Location:
--
Type of Facility to be Inspected*— _q, � No. Bdrms. a
8. Water Supply
Type of Supply
a
Public Utility_ -individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation A q —10
72-003(3/76)
Individual (on-site)
,-r r
Page 2 of two pages - Re st for Approval of Individual _ -Nr & Water Facilities
Legal Description Lot 6 Block 3 Huffman Subdivision #1
Comments
Date
Appro\(D�`Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
-7-
I
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
EQ -034 (1/74)
Date