HomeMy WebLinkAboutFIRE LAKE BLK 1 LT 14AOnsite File
Fire Lake
Block 1
Lot 14A
#051-361-10
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~:~ \ ~::>~ L~E~ PID Number: c~ ~ ~
Name~ ~, ~ ~ Wastewater System: ~ New ~Upgrade
Address:
~ ~~ ~ ~~ ABSORPTION FIELD
Phone: ~ ~ ~ No. of Bed~ms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so, Rating: Total Depth from ordinal grade:/
Lot~ ~ BIock:~, ~ ~ Subd~vision:~ ~ Depth to pipe botto~o~ originaIH~,grade: Ft. Gravel depth beneath pipe~ '~Ft.
Township: Range: Section: Fill added above original grade: I Gravel length:
WELL: D New ~ Upgrade Gravel~ Numberof lines: IDistancebqtw~enlines:
Classification (Priv~e, A,B,C): Total Depth: Cased To: Total absorption area: Pipe m teriah
Driller: Date Drilled: Static Water Level:Ft, ~ ~. Date~_~installed:
Yield:GPM Pump Set at: Ft. I Casing Height Above Ground:Ft. TANK
SEPARATION DISTANCES ~Septio U Holding U S.T.E.P.
TO Septic Absorption Lift Holding Public/Private M~uf~cturer: ~ Capacity in galion~
From Tank Field Station Tank Sewer Lines ~C~I~6 ~
Surface
water ~'~ ~'~ ~ / ~ ~ LIFT STATION
Lot I I Size in gallons: ~
Line ~ ~ ~ ~ ~ ~
CurtainDrain ~ ~ ~ ~ ~ Pump Make & Model Electrical Inspections performed by:
Remarks~~ ~ I~c~~ BENCH ~ARK
~ ~~ ~~ ~~1 Lo__ion:
Assumed Elevation:
ENGINEER'S SEAL
Inspections performed by: 17034. ',t~* :~lver,Eagle AlaskaR~ L~pees~Rad NO~s., 1 st ~' ~ ~ 1 /:;'~ . ,
2nd ~1
Department of Health and Human Services approval
Reviewed and approved by:~~ ~ Date: ~-/~- ?/ ~
72-013 (1/91) MOA 25
Permit No.
On-Site
Legal Description:
~[ [, C>C~ ~ ~ Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
stewater Disposal System and/or Well Inspection Report
~-',~"T ~",'~ ~L..-~/--, [ ~'/~---~ ~--,~'~ PIDNo.:
72-013 A (2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910068
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:JONES JANET G
OWNER ADDRESS:13901 MALASPINA ST
EAGLE RIVER, AK. 99577
PARCEL ID:05136110 ~~
LEGAL DESCRIPTION: FIRE LAKE~LK 1 LT
DATE ISSUED: 4/24/91
EXPIRATION DATE: 4/24/92
14A
LOT SIZE: 54000 (SQ. FT.)
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 (18AACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY: ~~~-~ ~~'~
April 22, 1991
ROBERTSHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
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
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 14A; Block I; Fire Lake Alaska;
PER~IT REQUEST NARRATIVE
The installation of the existing septic system serving this property
was undocumented. The system passed an adequacy test in 1983 and a
Health Certificate was issued for the property.
Upon inspection of the property for Health Authority Approval purposes
we found the water level in the seepage pit near the ground surface
with only a minimal amount of absorption capac~y.
The test hole was dug in the northwest corner of the property outside
several protective well radii. To install a leachfield in this area
the sewer line will need to cross the driveway, however, this site is
preferable to the south portion of the property which would probably
require a lift station. The property gradually slopes toward the
northwest.
We can foresee no adverse effects on neighboring properties by the
installation of the proposed septic system.
If you require additional information for your review, please contact
US.
(~.~'ROB,~RT A. SHAFER, P.E.
~/gm
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
1
2
3
4 ~'~ / ~_.111,~
6
7
8
9
10
11
12
13
14
15
16
17
18
lg
~'! .1~-~ ~_.jS~_ Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? D
S
IF YES, AT WHAT ~
DEPTH? P
E
Depth to Water A(t_[It[.._... ,¢~ ..-~..7.~,~1 \
Monitoring? "'~.-'~'~'~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
~/~
20-
PERCOLATION RATE \ L~ Iminules/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~AND7 FT
COMMENTS
PERFORMED BY: 1-~ "= ...... '/,~/} ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
Ea~le River, Alaska
ACCORDANCE WITH AL[ STATE AND MUNICIPAL GUIDELINES~T ~ ~S ~ D~E:
/
72-008 (Rev. 4/85)
MU n"icipali-ty of Anchorage
P.O. Box 196650 a 4700 Elmore Road
Anchorage, Alaska 99519-6650 a (907) 343-7904 G Fax (907) 343-7997
http:/Iwww.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
r
Waiver#: 05V171104 COSA#: Permit#:
PID#: 051-361-10
Legal Description: Fire Lake Block 1 Lot 14A
Engineer: Charles Balzarini
Applicant: Stephen & Laura O'Neill
Your request for a waiver of the required 100 feet horizontal separation from the absorption field
to the private well on Fire Lake B2 L 1 A has been approved. The approved separation distance is
96.0 feet. See engineer's waiver request for justifications.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
......................................... ■ ..... a ....................... ■ ..... E I
Waiver is Granted: X
Waiver is not Granted:
Date: Approved by: I�Ccw—&Zz-e
1 Name of Reviewer
Fire Lake 131 L14/\
P@[C8l I[): 051-361-10
Waiver for 96 feet from well to dr8infiekj
ISSU8d 9/22/17
General
Requested separation distance is just short of code required separation of 100 feet.
Effluent would have to travel across a road before it reaches the well head, so is unlikely to go unnoticed
and unaddressed for long.
If the well was redrilled to meet the 100' separation, the points calculation would be within the same
points interval.
ADEC Criteria Points
Water Table
Depth towater bearing layer 65 feet
Depth ofdnainfie(d 11.5 feat
53.5 feet
Soil Sorption
Soil descriptions per well log
DEC PTS
Depth From
Depth To
Thickness
Calc. Pts
Overburden O
0
5
5
0.00
Sand QGravel 1
G
55
50
077
silt 3.5
55
65
10
0.54
55
65
10
O
0.00
65
1.31
Permeability
Soil descriptions per well log
Not calculated
Horizontal Separation
96
xx
Total Points 9.9
As per ADEC waiver guidelines, with a minimum point value of 9.9, contamination is unlikely from
bacteria but could bepossible from chemicals orvirus. Based onpoint value, oswell asmitigating
DEC PTSDepthCa�
��
Overburden
O
D
-------'
Sand &Gravel
02
5
55
50
0.15
Silt
2
55
65
10
0.31
O
0.00
65
0.46
Water Table Gradient -
Not calculated
Horizontal Separation
96
xx
Total Points 9.9
As per ADEC waiver guidelines, with a minimum point value of 9.9, contamination is unlikely from
bacteria but could bepossible from chemicals orvirus. Based onpoint value, oswell asmitigating
Ph: 907-8545558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Waiver for Fire Lake Block 1 Lot 14 A
Dear Reviewer,
The above referenced property is currently served by well and septic system. An adequacy test was
performed and both the well and septic were found to be adequate with only minor repairs required. The
owner intends to seek a COSA once a buyer is found for the home.
Unfortunately, the septic drainfield was found to encroach on the well on Fire Lake Block 2 Lot 1A. The
distance was measured as 96'.
We are requesting a waiver of the 100' separation distance to 96'. We are requesting a waiver be granted
for 96'.
The well log on file for lot 1A appears to be illegible, however the total depth is 81', fully cased, with a
static water level of 46' at the time of testing in 1996, according to the Health Authority Approval Checklist
on file.
The well log for lot 14A is not available either; however the well log for lot Fire Lake Block 1 lot 12 shows
a gravel material to a depth of 38 ft, over a layer of hard pan starting at a depth of 54 feet. The water
bearing layer was found to be at a depth of 90'.
Nitrates in the area appear to be less than the allowable 10mg/L limit, in the range of — 5 mg/L. This is
consistent with the level of development and age of the neighborhood.
For these reasons we believe a waiver is appropriate for this encroachment.
Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558
or by email cgbalzarini(d_)gmail.com with any questions or concerns.
Sincerely,
arles Balzarini, PE
FIRE LAKE
BLOCK 2 LOT 1A
96' LEACHFIELD TO WELL
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10' UTILITY EASEMENT
LEGAL DESCRIPTION: FIRE LAKE BLK 1 LOT 14A
OWNER: O'NEILL DATE: 8/25/16 1 REV:O 1 DRAWN: CBJ REF:
WAIVER PLAN
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EXISTING
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LEACHFIELD FIRE LAKE BLOCK 1 LOT 14A
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10' UTILITY EASEMENT
LEGAL DESCRIPTION: FIRE LAKE BLK 1 LOT 14A
OWNER: O'NEILL DATE: 8/25/16 1 REV:O 1 DRAWN: CBJ REF:
WAIVER PLAN
EXISTING
LEACHFIELD FIRE LAKE BLOCK 1 LOT 14A
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LEACHFIELD
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NOT UNDER
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DRIVEWAY
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EXISTING SEPTIC TANK
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DRIVEWAY
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100' WELL T
TANK PER S&S
LETTER DATED
APRIL 14 2009
DECK HOUSE
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EXISTING WELL
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C&M ENGINEERING SERVICES
907-854-5558
LEGAL DESCRIPTION: FIRE LAKE BLK 1 LOT 14A
OWNER: O'NEILL DATE: 8/25/16 1 REV:O 1 DRAWN: CBJ REF:
WAIVER PLAN
•
•
Municipality of Anchorage a.�E
On-Site Water and Wastewater Program =
al(907) 343-7904 i °
SAWN'
r r
Certificate of On-Site Systems Approval
Parcel I.D. 051-361-10 >
Expiration Date: 4,
— +t 17. - c
1. GENERAL INFORMATION
Complete legal description Fire Lake Block 1 Lot 14A
Location (site address) 13901 Malaspina
Stephen O'neill 622-2030
Current Property owner(s)
Day phone
Mailing address 13901 Malaspina
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver/Variance request for: none, waiver on file
Distance:
C
Received by: / ✓ , / t
Dateg /(
COSA to be released to the engineer,unless of er ise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment `i•-9-'( -(o Date of Payment
Receipt Number O', 6 t-'? Receipt Number
COSA# opL 101 N6-7 Waiver*
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm
C&M Engineering Phone 8545558
Address 20182 Tulwar
Charles Balzarini Date 7/24/2018
Engineer's Printed Name � :KVO
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6. DSD SIGNATURE . . ../.1
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System#1 Approved for g bedrooms ' • �t J f^
N•'RLES G BALZARINI ?;•
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System#2 Approved for)6bedrooms F•• CE-13854 • ••.c`(' ^='
Disapproved F4 • '. . . . . `'c.
'�.� .-PROFESS\ON,� y.
Conditional approval for bedrooms, with the following s:lts4 , -,4-n
96
�` ON SITE ��,
WATER AND r'...
m WASTEWATER z:
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PROGRAM
7. f,^ Gam\
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By: -- \ \--`----(..."--CieCt-,----( Original Certificate Date: CC— 3 ^i g
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: y______
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other _
?C
COSA blue sheet_f • c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: FIRE LAKE BLOCK 1 LOT 14A Parcel ID:051-361-10
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID # Well Log (Y/N) NO
Date completed UNKNON Sanitary seal (Y/N) YES Wires properly protected (Y/N)YES
Total depth +78 ft. Cased to +40 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test NA 8/1/2017
Static water level NA ft. 68 ft.
Well production NA g.p.m. +6.5
g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 9.43 mg/L
Arsenic ND ug/L Date of sample: 07/15/2018 Collected by: Charles Balzarini
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 5/6/91**
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) yes
Foundation cleanout (Y/N) yes Depression over tank (Y/N) no High water alarm (Y/N) no
Date of pumping 07/13/2018 PumperJ Rs
C. ABSORPTION FIELD DATA
Date installed 5/6/91 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System typetrench
Length 50 ft. Width 3 ft. Gravel below pipe 7.5 ft.
Total depth 12 ft. Eff. absorption area 750 ft2 Monitoring tube yes Depression over field no
Date of adequacy test 8/1/17 Results (Pass/Fail)PASS For 4 bedrooms/
Fluid depth in absorption field before test 38 in. Water added 600 gal. New depth$8_& in.
Elapsed Time: <14w min. Final fluid depth 8'1` - Din. Absorption rate >= 600
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date NA
D. LIFT STATION
Date installed no lift Size in gallons -- Manhole/Access(Y/N) --
"Pump on" level at-- in. "Pump off' level at -- in. High water alarm level at -- in.
Datum -- Cycles tested -- Meets alarm&circuit requirements?--
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100 On adjacent lots +100
Absorption field on lot +100 On adjacent lots +100
Public sewer main+100 Public sewer manhole/cleanout +100
Sewer/septic service line +25 Holding tank +100
Animal containment areas +100 Manure/animal excrete storage areas +100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +10 Property line +5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line +10 Building foundation Water main +10
Water Service line Surface water +100 Driveway, parking/vehicle storage 1
Curtain drain +25 Wells on adjacent lots 961*
F. COMMENTS
**Tank was installed in 1991 and appears to be functioning adequately, but is nearing the
end of its usefull life. *WAIVER # OSV171104
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G. ENGINEER'S CERTIFICATIONANY
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I certify that I have determined through field inspections and orAQ;•••• •• �
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review of Municipal records that the above systems are in CV •.9
conformance with MOA COSA guidelines in effect on this date. ;iv * TH
Engineer's Printed Name CHARLES BALZARINI
Date 7/24/2018 I✓ • • • •• • • • • RINi
ARLES G BALZARINI
7 AV•• C -13854 • ZI
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COSA canary sheet_2-6-15.doc
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RECERTIFICATION 5-7-91
ASBUILT-NO CORNERS SET THIS DATE.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE'
SEWARD & ASSOCIATES I, gpgyl -4566
FOLLOWING DESCRIBED PROPERTY: I"s30' •6t7�
Fire Lake,Alaska Subd. Lot 14A B1k. 1 •-c Off./. 4
AND THAT NO ENCRO4CHMELNTS EXIST EXCEPT AS DATEr •
•
INDICATED. IT IS THE RESPONSIBILITY OF THE 4-2-91 •r 1;••'�• -•�J q'•-a•
OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS i* 4.�9 al````.�1••,•':�•
EASEMENTS, COVENANTS, OR RESTRICTIONS 1:i. �'-•0,ir
WHICH DO NOT APPEAR ON THE RECORDED SUM... h'W 453 !
VISION PLAT. UNDER NO CIRCUMSTANCES SHOU..D Fa: 1?K o-•�.�..w s...,�
ANY DATA HEREON BE USED FOR CONSTRUCTION 19-52 !4 C�'•• l5•b918 lyt•i
OF FENCE LINES, OR FOR ESTABLISHING BOUND- + `'F•,' ••5�%••
ARY LINES. DRAWN:
1• ••> -�+� dp
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MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT fr '� 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC181367
Subdivision: Fire Lake Block:1, Lot: 14A
The septic tank for this property is 27 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
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Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT (go i f
`� 907-343-7904
On Site Water and Wastewater Section \ j Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181367
Subdivision: Fire Lake, Block: 1, Lot: 14A
A water sample revealed a nitrate concentration of 9.43 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen,which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
~.. ~ MUNICIPALITY OF ANCHORAGE
..~:?~.~,,:,: ..~ DEPARTMENT OF HEALTH & HUMAN SERVICES
Divlsioh of Environmental Services
'-":~'; ...... On-Site Services Section
....... '- P.O. Box 196650 Anchorage,-Alaska 99519-6650
;~i~,:~,; ;':'- *';:,'i. .... * '.' , ;? ,~+-'~.)~ :':,~'~ *'~'"~ ;' '
~ , . ~,,=:,;, CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
p~r~eli.D.# D~'-J 7(..j~O
1. GENERAL INFORMATION
...... *~,!~'i_Complete legal description
lalling
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.... or dire~tion~~?''?? 90~
"" ::.~: :' ':: ?::':% "~';.~ E~g£~ River, - AK
450 E£do/~zdo .,~£vd.~..# ~ L16 We. b6"~e~,
Day phone
TX 77598
g .agency'
lng address .....
Day phone
16600 C~,nt~ficld Drive.
Unless otherwise requested, HAA will be held for pickup.
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system~ : . -,-.. . . ~ , \ ~.,~,
2. NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
Y, XX
-: Individual on-site:- -: -
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
Engineer's sig~
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validabon date shown below, I verifY th~lt~rny
investigatio~ of this Health Authority Approval'applicati0n'shows that t~e~n-site water supply
and/or wastewater disposal system is safe, functional and adequa, te for the number of bedrooms
andtype of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my inves.ti_gation and inspection, the on-site water
supply and/or wastewater disposal system is in coml~lian~e ~tt~ all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
c~..:~'~ ~ 6..~.3_,
~ ....................... Phone .....
Addr Rod No. ......
nature- - Date"
'i".,.' ~ :.~:', '., ';~- ~g~,~r~ '~"~'~.,.;~ .~t;.~?;" , '. ' ".L;7t' ":: 7 ' '.' .: 't.
· ~:[',L'~'t:! ppr0v~ for" '
~":~" " Conditional approval for
, .- ' .~'7'~ * -
bedrooms; with the fol owing st p61at ons:
'Additional :Comments
~.--.The nl~ipality ol'~Anchorage Department of Health and Human Services (DHHS) msuas Health Authority
'¢~oDroval ~.~rtlf[~t~ .based only upon the representatmns g~ven ~n .paragraph 5 above by an ~ndependent
'%or>dfessiona, e~l'dJ~'~r1'eglstered,~.~, -- ,n the State of Alaska. The DHHS does th ,s as a COUrtesy to purchasers of homes
t~'~i~tending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
and
conduct insp~::tions or analy',e data I:~fore a certificate is issued..The Municipality of Anchorage is not
responsible for en;or~"°r omissions in the professional engineer's work.' '" ...............
Municipality of Anchorage ,~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:/-~+ /'M~;/7/~¢~//'£,%e Zo./c~ Parcel I.D. 0 ~'-'/
A. Well Data
Well type /°r' / ~/~t '/- ~.~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) ~ Date completed d//_.- Driller
Total depth ~ ~, ' ../L Cased to /-7/ ~ "-/' Casing height
Sanitary seal (Y/N) y Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test X~, .~ - ,2 6 ~ ?S
Static water level .__'~\ G' ~z
Well flow g.p.m, z/. ~ +
Pump level1 0
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot / G 0
Absorption field on lot ? ~ ~' /
Public sewer main ~' o,.x,, ~
Sewer service line -'~ ~/_ ~
g.p.m.
; On adjacent lots
;On adjacent lots
Public sewer manhole/cleanout
Petroleum tank /t/o,,~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date inst,alle~! ,~
Nitrate
Collected by:
Tank size / ~. -5- o
Other bacteria ~
S & S ENGINEERING
17034 Eagie I<iver ~.gq~p =~v.. ,,.,.. -,,.-'-.
E.a~{e River, Ala,~ka 99577
Compartments
Cleanofits'(Y/N):I ~,.. ~/ . '~;, Foundation cleanout (Y/N)
' % ,' / :~, ,
High water alarm (Y/N)' , ~,z.,,/~',
Date'of.Pumping .. ,,~- .~ ~ u - ~/~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on 10t.~.~: ,J ,.~ ." /
To property line // ;
Depression (Y/N)
Alarm tested (Y/N) /1./. ,~.
Surface water/drainage
On adjacent lots
Absorption field
' Y' Foundation ~ ~/ /
Water main/service line
/0/ -/-
72-026 (3/93)' Front CONTINUE D ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer /
.Ma~N~ff,, Level at
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTAN~STATION TO:
Well on lot ,./' On adjacent lots
D. ABSORPTION FIELD DATA
Cycles tested
Sudace water
Date installed .5"- ~- ~ ?// Soil rating (GPD/Ft2) O, f5
Length .5-0 ~ Width .~ / Gravelthickness '7z. 5-
Total absorption area ~z. 5 O ~ ~'
Cleanout present (Y/N)
Date of adequacy test ~" -- .,7. 6 - Y ~ ,,°.5- Results (pass/fail)
Water level in absorption field before test J/-- y o *'
Peroxide treatment (past 12 months) (Y/N) ~ O
~,' Depression over field (Y/N)
/
,~ ~'.5' ~'" for /7/
After test ,~ 5
If yes, g~e date ~. ~
.System type ~'"~" ¢ ~
Total depth /'/'..3'-
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,/~ ~
To building foundation
On adjacent lots ..~
Surface water ,/~
/
On adjacent lots ,,' O ~ Property line
~' ~' ~ ,5- To existing or abandoned system on lot
~ "~ Cutbank /t/~,,'//c--- Water main/service line
~ ../L Driveway, parking/vehicle storage area 3 /
Curtain drain ,,~o~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecto~sinspection.
Signature
Engineer's Name
Date
__ ............... ;",? .,,
HAA Fee $ ~ (:~. ~ Waiver Fee $
Date of Payment ~"~///',/~< ' Date of Payment
Receipt Number .,/~-~ ~ ~t/~.--w~',/°'z/z',/) Receipt Number
72-026 (3/93)* Back
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
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description ~,¢ 14A,:
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~ ~ / - ,~ ~ / ~ [ g- __ HAA # ~e~c~-\ ('")"~i,'-,'-'~
Bla~ 1;~.¢- LakcvAlaska SubdivisioJ~
Location (site address or directions) 13901 Ma~asp~n
Property owner Arthur
Mailing address_13901M~a~p¢n~ Eagle Rive%~a 99577
Lending agency Day phone
263-2544
Mailing address
Agent Barbara Bowd~n ERA PROFESSIONAL, REAL ESTA~ay phone
Address 2702 G~mbell Street ~200 Anchora,q~, Alaska 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
NOTE:
278-2776
XX
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
XX
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72-025(Rev. 1/91) Front MOA #21
Note:
STATEMENT OF INSPECTION 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.
Name of Firm
s & 5 ?.?4G~;'~E''W'NG
Address ~7331 !:~le River Loop Road No. 204
_, F.a~le River, Alaska 99577
Engineer's ~gnature'
The well for this property meets existing
Municipal Codes. There are nitrates presen~j
It is suggested that periodic testing be
performed to insure the well's continued
suitability. Nitrate concentration is
5.8 mg/1. EPA maximum concentration is
10.0 mg/1.
~D~S
SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date_
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~)25 (Rev, 1/91) Back MOA 1¢91
Municipality of Anchorage ,~ ~'~'~,~i~,
Department of Health & Human Services ~,-.,~ .,.
HEALTH AUTHORITY APPROVAL CHECKLIST ~ ~ " '~'
/~:~F'l~dr-A ~Z. ~ ParcelI.D. ~~[[~c~/O,~ ,c~,
Legal Description:
A. WELL DATA
Well type
Log present (Y/~::)
Total depth "7~ ~ Jr
Sanitary seal ¢i~N) "('
If A, B, or C, attach ADEC letter. ADEC water system number
t 7'7
Date completed L)~_-. ~c~C:>~ 'Driller L~d--,
Cased to '~d¢c:? ~ Casing height \~.
Wires properly protected~__~) '7/
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ['~
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank .t~.t,~
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ~d?_ ~.,-~ _~ \
¢~'~//'~ Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~- - ~ - ~ t,
Cleanouts~/N) '-f
High water alarm (Y/N)
Date of pumping ~
Tank size \'~ ~'- c.)
~)undation cleanout (:~N) ¥
Compartments '~-
Depression (Y/~)) r~
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \ c:::z~l On adjacent lots
To property line I [ Absorption field
Surface water/drainage \ C-~ ~
t, L.~._~ ~ ,~ Foundation (z?~~
'~'~ Water main/service line \ ~ I'jr-
72-020 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION ~/~
Date i~ed
Size in gallons~~
Manufacturer
Manhole/Access (Y/N)
Vent (Y/N) "Pu m p on~aL~..~ "Pump
off"
level
at
High water alarm level .~
Meets MOA electrical codes (Y/N) ~
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~-- ~,-~ / Soil rating O,~d-~¢¢~x~ z_ System type '"-~d_
Length ~'-c::> Width ~ Gravel thickness '"7 ~' ~Total depth
Total absorption area Cleanouts present~/N) "/" ,
Depression over field (Y~I~ r'~ Date of adequacy test /,z~
for
Results (pass/fail) /*'X/~/,~ ~y ~'~
Peroxide treatment (past 12 months) (Y/~)
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot \ '--~-~ On adjacent lots ~, c:~. Property line
To building foundation (~(~ ~-- To existing or abandoned system on lot
On adjacent lots .~<::~t ,~ Cutbank I~ ~ ~ Water main/service line
Surface water ~. c::~-~ I'-~ Driveway, parking/vehicle storage area
Curtain drain ~X]C> ~-~ ~'~\~J
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on thedate 'df this inspection.
Signature
Engineer's Nam~.a~le E~ver, Ah
/_
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
PPLI(' NT FILLS OUT UPPER HAl '= ONLY
Phone
81ngm ~am~ly ,
Multiple Family No. of Bedrooms~.' ~
Other
r Supply A~ACH WELL LOG. A w~l Icg Is required for all wells drilled since .June 1975.
Individual For wells drilled prior to that date, give well depth (attach Icg If available).
Community
Public Utility
S~w~f Disposal Year Indiv~ual Installed: ~
~ Indivtd,al When Connected to Public Uti,tyf
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time
Date
Date Date Date .~-
Inspector
Insp~tor Insp~tor Insp~tor ~D~
Field Notes: . ~ ~ MUNICIPALI'rY OF ANCH~GE
ENVIRONMENTAL PROTECTION
( ) DISAP~OVED
_BY. ~¢
Soils Rating ~ Date .wer Installed ~ Well To Absorption Area ~ed
WRII to Tank ~ Septic T~k Size
72-023 (3182~j~
MAY 6 1983
ALASKA USA/REAL ESTATE DEPT./ATTN MR. BEHRENDS
POUCH 6613
ANCHORAGE AK 99502
SELLER - JAMES COAN BUYER-JONES
SUBDIVISION-UPPER FIRELAKE BLOCK-1 LOT-14A
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A UNKNOWN WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 5/6/83 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF
THIS 3 BEDROOM HOUSE.
1000 IS ADEQUATE FOR
1200 ~UcsI 33r~ Au~nue, Suil¢ ~ · Anchoro§¢, Aloskr~ 99503 · [907) 276 1361
· . DATE RECEIVED
INSPECTION APPOINTMENTS ~;~. ~.~_.~._j,
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSPE INSPECTOR I
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
e DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(~I~PT' OF
825 L Street - Anchorage, Alaska 99501 ENVIRONM[.iq i,:,L ;. i '..CTION
ENVIRONMENTAL SANITATION DIVISION FEB
Telephone 264~720
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be preceded. Please allow ten (10) days for processing.
1. PROPERTY OWNER ~ PHO~
MAILING ADDRESS '-'
PROPERTY RESIDENT (If diff~ent from above) ) ~ ' ' ' PHONE
2. BUYER PHONE
MAI LING ADDRESS
~. LENDING INSTITUTION I PHONE
MA'ILING ADDRE88 ' ' ~
4. REALTOR/AGENT
PHONE
MAILING ADDRE88 ' '
J
0. TYPE OP RESIDEN~E-
[~/'~slNG LE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Five
e [] Six
[] Other
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG, A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) II '"h
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
r--~Septic Tank or [] Holding Tank
Size: lt~)~--~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septlc/Holding Tank ]Absorption Area ISewer Line INearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~ APPROVED FOR -'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must ~/compan¥ certificate)
[~'~DISAPPROVED
72-010 (Rev. 6/79)
'lF(::bruary 17, ] 98 ].
Subjoct: L,)t BP, I/toc,t ] Fir(? [3,:;k~, Sul;,: J'~.;i. sio~
(2) ']'h.e. scl)bi c La:nk p'Lmt :e.d wi~:h ,,t z:-(;~.:(:::i, pt. snl ',nj t (:d
I: h i s o :[' f :i <:: e,
caE] t:hJs
qinc:erely
Rober!: C. Pr;).L.I::; P..S..
A s ;3 o c J a t e S p e c .i a 1 :i. ~: t:
Rcp/.1.:jw
cc:: FJ]'s'L Alaska Hor:~ gage
99503
5'1].4 Pr'cuss l,ane g9517
DEPARTME,
825
IIi.: Time 10:30 a.m.
Date 12-9-77 Friday
Insp Pratt
MUNICIPALITY OF ANCHORAGF
OF HEALTH AND ENVIRONMEN',
L Street, Anchorao~. Alaska
264-4720
PROTECTION
99!501
Date Received: December 6~ 1977
#2: Time
II 3: 2 ].me
Date
Date
Insp
In sp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER i~ACIL1TII~,o
1. Lending Institution Request: Farmer's Home Administration
Mailing Address: Post Office Box 819 99645 Phone: -
2. Property Owner: Linda Parker
Mailing Address:
Phone: 688-2020
3. Legal. Description: Lot 8A Block 1 Firelake Subdivision
4:
0
Single Family Residence: (9
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
Three
Well System:
Permit #
Construction
Individual well W~ Con. unity/Public System ( )
Depth of Well Well Log on F~le (x)
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System ~ )
Installed 1977
[~OO Manufacturer
Soils Rate
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
Public Utility ( )
Installer
Material
to AbsorptJ. on Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 8A Block 1 Firelake Subdivision
Comments:
Affadavit Attache~)
Approved:~_.~~ Date:
Disapproved: Date:
Letter Attached: ( )
.l~t ~ ?22
'Department Worksheet:
~UNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
~equesn zor Approva~ ox .Ln v ....... Water Fa(:il
Mailing Address: Phone ~".~ '
o
Mai].inq Address:
Phone:
Street Location:
Single Family Residence: ~ Number of Bedroolns:
Multiple Family Res:i.dence: ( ) Number of Bedrooms:
Water Supp].y: *Individual Well ~) Public/Communi tV System
(
)
If Individual Well, well depth
o
If Community System, name of system
Sewage Disposal. System: *~Dn-site System (X Pul0]ic System ( )
If On-site System, date of installation: _/_~P/_?__?_
*NOTE: A well log :is required on ALL wells drill, ed since 6/75.
** If on-site sewer system is over two(2) years old, an ade~{uacy
Lest is required by this department.
A fee of $25.00 must accompany each request be[ore pr'ocessing
can l')e initiated.
3/77