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Home My WebLink AboutEARL RAY BLK 3 LT 24 GREA' ,R ANCHORAGE AREA BOR 6H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH LEGAL DESCRIPTION MANUFACTURER ~/~£ INSIDE WIDTH MATERIAL LIQUID DEPTH __ NUMBER OF COMPARTMENTS J .LIQUID CAPACITY /O~)O GALLONS. SEEPAGE PIT: NUMBER OF PITS ] DIAMETER ~-/~ OR WIDTH /?,, LENGT,/?~ DEPTH LINING MATERIAL (~"I~;L CRIB SIZE: DIAMETER ~'7~'DEPTH G I DISTANCE FROM: TOTAL EFFECTIVE BUILDING FOUNDATION ~(, NEAREST LOT LINE ~01~ . ABSORPTION AREA (WALL AREA) WELL SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEPTIC SEWER LINE TANK REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-O31 DIAGRAM OF SYSTEM ;I GReATer ANCHOrAgE ArEa Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274o4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPe AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS ' COMPLETION DATE ANTICIPATED SEEPAGE PIT ~ DRA~N FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /~ TYPe MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT _, DRAIN FIELD SEPTIC TANK TO SEEPAGE PiT WALL--~'-/~[ , SEEPAGE PIT ,DRAIN FIELD I /oo' SEEPAGEP'T ALSO CONSIDER AREA WELLS. SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD SEPTIC TANK,~--~ , SEEPAGE PiT''~/(00'~ , 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 F~T~_~TED iWIT~H AiRTiGH~T RE__MOVABLE CAPS~ ,~ ,~, / DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOR( )UGH 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 DESCR D SYSTEM IS IN ACCORDANCE WITH SAID CODE. 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. # ~"~\ 1. GENERAL INFORMATION Complete legal description L ~-4 8~ ~,~4~- ~/ sug. Location (site address or directions) ¢_o'~c~ ¢~tc~-,~¢~ Property owner Mailing address Lending agency Day phone (o ~&~-2.~'~ ~ ~ ,~_ 'h ff ~-l'1 Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well 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: NOTE: Individual on-site /~ Holding tank Community on-site Public sewer 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 STATEMENT OF INSPECTIO~I BY ENGINEER 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 application 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. NameofFirm ~'¢' P~u~.A,,~ co,,~s~_-n,,~(= ¢~&W-S. Phone Address 7_o~ u,~. i'~'~-k ~c~HoF. Ac~, AY-.- °~'~SO f Engineer's signature 6. DHHS SIGNATURE XX Approved for FOUR (4) bedrooms. __ Disapproved. Conditional approval for Date ~/~. !?-~'~ bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is continued suitability. Nitrate concentration is 6.2 mg/1. EPA 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. 72-025 (Rev. 1/91) Back MOAI¢21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lega Description: L-~.4 /5~ F--,~,~- ~.A~' Sub Parcel I.D. A. WELL DATA Well type '~'¢.;t/AT-'~ ~;~ Log present (Y/N) Total de pth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter, ADEC water system number Driller Date completed Cased to t I~r(~) Casing height I. '~' (2) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION lC) t~) g.p.m. ~ ;On adjacent lots t~**eT ~o~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot to~ ' ~ Absorption field on lot ~'~:~' + (D Public sewer main ~/'~ Sewer service line ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~,~c.$ ~ Nitrate Date of sample: ~-~)'~ ~ q '2_ ~ Collected by: Other bacteria C,~-c ~,~ ~A,~ B. SEPTIC/HOLDING TANK DATA Date installed "[- 1 ~r (~) 1'~' Tanksize [3oo ,~.~ ~) Compartments Oleanoute (Y/N) ~ ~)(rc~[) Foundation cleanout (Y/N) ¥' (~) Depression (Y/N) High water alarm (Y/N) t~/.~ Alarm tested (Y/N) Date of pumping l-ii- ~2. Pumper .[.t( . Well(s) on lot I O~ ' To property line I°°'*- Surface water/drainage 72-026 [Rev. 7/91)Front ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN K TO: , On adjacent lots ¥"~'-r t~o' G) Foundation Absorption field '51 -to 6t/~0~E, Water main/serviceline N/A CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at Manhole/Access (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot -- On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed [~t'l~r ~ ~l~/~ Soil rating F--%T ~55 Length .!4' fid Width I~" ~) Gravel thickness Total absorption area (~) ~'~¢o 5F Cleanout, present (Y/N) ':' Depression..over f e d (Y/N) ~ Date of adequacy test 'Results (pass/fail) ~'A.c~% (D ..~ for Peroxide treatment (past 12 months) (Y/N) ~G)o~'~rr~ ~,~o~-~ System type SEE, e',aGE_ Total depth If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~%t~ + {~) '~+ ~ On adjacent lots I z-t~ Propertyline To building foundation (~1 ' (~) To existing or abandoned system on lot On adjacent lots ~,,Ac,'** (~) Cutbank I~o~ (E) Water main/service line Surface water Curtain drain iOO'-¢ (~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature N~~ Engineer's Date HAA Fee $ / .TD ,. ~ Date of Payment ~'- ~//"-' ~ ~ Receipt Number '~,'"7 ~ ~, 72-026 (Rev, 3/91) Back MOA 21 on th~4~of this inspection. 0 ,F. ...' 4~'~,~ Waiver Fee: $ Date of Payment Receipt Number CHEMiC 4 GEOLOGICAL LABORATORY A DIVISION dF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Client S~aple ID : L24 B3 EAR5 ~AT SUB, PWSID : UA Collected : kUG 20 92 ~ 1l:50 :ecs:red : AU~ 20 92 @ 14:00 Proserved ~ith : kS ~EQUi~E~ Client Name :HIGH PHU~N CONS Client ~cct :HIGt~HU BPOS : POS :NON[ ~ZCEIVBD [eqS : Oxdered ~y :Cl6~L Analyei~ Completed : AUG 24 92 Send Repozta to: i)HIGH PHUKMI CONS ENGR Labo:a:ory Snpe%v~or j STEPHEN C. Pa=ameter ~esults Units Method Allowable Limits NITBATE-N 6.2 m~/l EPA 353.2 Sa:.,'mi~ ,~.OUTI,~I~ SAMMLE COLLECTED ~¥: C.M.A. '" ~,~SGS Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE ~:~ ~1 / / ~ 90 : DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL H87-0243 OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PR OR TO SUBMITT, AL) (a) Legal Description (include lot, block, subdivision, section, township, ran. ge) Lot 24 Block 3 Earl Ray Subdivision (T15N R1W Section Location (address or directions) Chickadee Lane PropedyOwner Linda Halterman Telephone: Home 688-2175 Business 694-5800 MaiHngAddress PO Box 770581, Eagle Riverf AlaSka 99577 Lending Institution 1st National B~nk of Anct~t~Uc31~f~e Mailing Address PO Box 100720, Anchoraqe, Alaska 99510 (bi (c) (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or; Check here I--]. if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Family [~x Numberof Bedrooms four (4) 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental ,G0nservation 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. Page 1 of 2 72-025 (Rev 8/863 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 Enqineerinq Ser~r~ne 694-5195 Address PO Box 773294, Eaqle River, Alaska 99577 Date Engineer's Seal DHHS APPROVAL ~~~ Approved for four (4) bedrooms by Approved ×XXXXXXXXXX Disappro~,ed Terms of Conditional Approval Conditional Date November 23, 1987 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 (Rev 8/86~ Back EAGLE RIVER ENGINEERING ERVICES Lou Butera, P.E. November 20, 1987 Mr. Dan Roth Municipality of Anchorage Department of Health and Human Services Pouch 6-650 Anchorage, AK 99502 P.O. Box 773294 Eagle River, Alaska 99577 Telephone (907) 694-5195 DF.PT. OF HEALTH & EN¥1RONI~4F. NTAL PROTECTION : IOV 0 987 RECE!V_ED REF: Lot 24, Block 3, Earl Ray Subdivision Dear Mr. Roth: I submitted a Health Authority Approval Linda Halterman for a 4 bedroom approval for On May 1, 1987, application for a Mrs. the above referenced lot. The existing septic system was installed in 1974 and was noted as being a 3 bedroom system. As the house contains 4 bedrooms, approval was required for a 4 bedroom system. Our adequacy test demonstrated the capacity to provide a 4 bedroom, 600 GPD absorption rate. Looking at the original inspection report, it was discovered that the septic system absorption area was miscalculated; a 15'xlS'x6' deep pit provides 360 square feet of absorption area. There was no soil log on file and there was a comment that good gravel was evident. As a result and after consulting with Dan Roth, it was decided to dig a test hole to determine soil rating to verify system adequacy. The test hole revealed a GW soil with a rating of 85 therefore making the existing system adequate for 4 bedrooms. The septic tank was pumped and found to contain 1300 gallons capacity, a normal capacity for concrete type tanks which are commonly oversized. My client still does not have a record of 4 bedroom approval and we were not aware of it until this time. Please process an updated blue form so that the m~tter may be resolved. If there are any questions or concerns, please feel free to contact me at 694-5195. Sincerely, Louis Butera, P.E. LAB:bjr ', 1 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 264-472O Application Date 1. GENERAL INFORMATION (a) MAY 1; lq87 Legal Description (include lot, block, subdivision, section, township, range) T,nt 24: Block _R: ?ARL RAY SUBDIVISION: T15N; R1W~ Section 10 Location (address or directions) CHICKADEE LANE, 3RD HOUSE ON RIGHT (b) Applicant Name LINDA HA~ Telephone: Home 688-2175 Business 69b,-5800 Applicant Address P.O. BOX 770581: ~AC, f,R RIVER; AK 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder]~l'; Buyer []; Other I-I (explain); (d) Telephone n/a, AK 995~ n (e) (f) Lending Institution lqq'R,grg NArpTf~NAT, RANK Address _P_O_ 1~q¥ lf'if~7?C)' ANP, Nf~RAP, P:,; Real Estate Company and Agent Address n,/a Telephone n./8 Mail the HAA to the following address: PTP,~ lIP BY OWNF,.,R 2. TYPE OF RESIDENCE Single-Family J~ Multi-Family [] Other Number of Bedrooms IIII .~ J~ Pt~R 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. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-o25 (11/84) ENGINEERING FIRM PROVID[ INSPECTIONS, TESTS, FILE SEARCH, r A 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.~,,/,.~,~,z~ ~ ~' ~',~,~,-~..~ ~Z,~e,~_,.~ ~-, ~ ~h Name of Firm RA~,~ R~R ~T~R~N~ RRR~CRS Telephone 69~-5~95 Address p.Q_ Date ~ 7 DHEP APPROVAL Approved for 3 f Approved ~ Disapproved Terms of Conditional Approval Conditional 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 (11/84) MUNICIPALITY OF ANCHORAGE (MO*-, HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST ' FEBRUARY 1984 264-4720 Legal Description: 7'-13- ~v (C ~ ~ .-~.~ /10 Well Classification .~' Well Log Present (Y/N) Total Depth ,//7 / Cased to Static Water Level ~ ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) 'Y 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 ~/,,'~ Water Sample Collected by ~-~'5/~" Water Sample Test Results v If A, B, C, D.E.C. Approved (Y/N) Date Completed ~/7~/ Yield l/Z~ ' Depth of Grouting ~ Pure p Set At z~r'/~°"~ Sanitary Seal on Casing (Y/N) Depression Arou nd Wellhead (Y/N) ~ , On A(~joining Lots ~'/~'~ / ; 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/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line '~'/o Course ~"~ Commems Air-tight Caps (Y/N) Size'- /3~ ,~ { No. of Corn partments / Y Foundation Cieanout (Y/N) Date Last Pumped ,,t/j~ ; for Tern porary Holding Tank Permit (Y/N) ~//'~' To Building Foundation 3'2 / To Disposal Field '~4" To Stream. Pond, Lake, or Major Drainage Page I of 2 72-026111/84) ABSORPTION FIELD DATA Soils'Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area ~,~ Depression over Field (Y/N) A'J 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 ~ ..C~,~ ~., ,: .¢~v.j- ;~_....~ .¢/7_~.. ~.~ 1~--~' LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Type of System Des!gn 1.5-" 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 -~ 3,~ / To Cutbank (if present) 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 and HAA guidelines in effect on the date of this inspection. Signed ~. ~~=~ Date MOA No. Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72~026 (11/84) · MUNICIPALITY OF ANCHORAGE, ,~,L p.OT~=TIObl ' E3 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~ PERFORMED FOR: //~//-~""~" ~' · EGAL DESC.,PT.O.:~/'~' 3 SOILS LOG 10 11 PERCOLATION TEST 12 14 15- 16 17 18 19- 20- DATE PERFORMED: '~/~'/"~ SLOPE COMMENTS '~' /~/~ PERFORMED BY: WAS GROUND WATER /~/~. S /.~,~,4-~ L ENCOUNTERED? ~,~//~,~, ' pO E IF YES, AT WHAT DEPTH? Reading Date K'/.~- PERCOLATION RATE TEST RUN BETWEEN SITE PLAN Gross Time Net Time Depth to Water Net Drop - FT AND CERTIFIED B~~ .... minutes/inch) -- FT 7~-008 ~6/79) RENT-A-CAN CO. INC. P.0, Box 770433 Eagle Rivet', AK 99577-0433 DATE REC'D BY ) KEEP THtS SLIP FOR REFERENCE 5L$28/01S28 ...r~.. ~. =~rb~.l==~ P.O. ~ox - '"" '" ' EAGLE RIVER ALASKA 99577 DATE STAT '~ENT ) Phor~e 694-519B TERMS: PLEASE DETACH AnD RETURN WiTH YOUR REMittaNCE BALANCE FORWARD '"'~qUNICIPALITY OF ANCHORAGE DEPARTMENt. OF HEALTH AND ENVIRONMENTA_.PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: October 27, 1977 Time Date In sp bpD/L 82: Time llLq/~ ~]~ 83: Time ~ Date 11~7~;,~ Date REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WkTER FACILITIES 0 Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 276-6300/490 Property Owner: Allan S./Mary C. Anderson Mailing Address: Post Office Box 239 99567 Phone: 688-3036 Legal Description: Lot 24 Block 3 Earl Ray Subdivision 4: Single Family Residence: ~) Multiple'Family Residence: ( ) 5. Well System: Individual well ( ~ Permit 8 Depth of Well Construction /~ ~/ 6. Sewage Disposal System: On-site System Permit ~ Installed / ~ ~ Septic Tank Size Absorption Area Number of Bedrooms: Number of Bedrooms: Three Community/Public System ( ) Well Log on File ( ) Bacterial Analysis Public Utility ( ) Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: VA FHA_ .CONV 2. Property Owner: Allan S. Anderson & Mary C. Anderson Mailing Address: ?. O. B_ox 239 Chu~iak AK. 99567 Day Phone: 3. Name of Buyer:_ John R. Halterman & Linda L. Halterman Mailing Address:_2_, O- Box 581_E_~gle River AK. Day Phone: 688-2175 4. Name of Lending Institution: First National Bank of Anchorage Mailing Address: P. O~ ~ox 720 Anchorage.~ AK. 5. Name of Realtor or Agent: Muldoon Realty Mailing Address: 322 Muldoon Rd. Anchorage, AK. Phone:. 337-1577 6. Legal Description: Lot 24, Block 3 Earl Ray Subdivision Location: NHN Chickadee Street 668-3036 Phone:__276.6300 Ext. 490 7. Type of Facility to be Inspected:_ Single Family 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well_ 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. Individual X Individual (on-site) MUNICIPALITY OF ANCHORAG,': DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 2, 7 1977 RECEIVED 72-003(3/76) Page ~wo Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 24 Block 3 Earl Ray Subdivision Comments: Affadavit Attached: Approve~, Dzsappr~t: Department Worksheet Letter Attached Date: //-- /~ Date: