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HomeMy WebLinkAboutFOUR WAYS BLK 1 LT 4 Municipality of Anchorage Page i of -'~ 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: ~M,J ~ ~.. c) ~ PID Number: ¢-'~ \~- (C~ ~.'~ - ~%~ [~ ~ ) ~~ ~ Wastewater System: D New ~Upgrade ~ddress: ~3~ ~, ~- ~¢~d¢ ABSORPTION FIELD Phone: ~~ ~ ~ No. of B~rooma: I ~ . ~ ~. ~eepTrench ~ Shallow Trench D Bed ~Mound ~Other soil Rating: To~ Depth fro~ original grade: LEGAL DESCRIPTION o.~ ~o/s~. ~. I~' Lot: ~ Block: ~ Subdiv~ion: Depth to pi~ bosom ~rom original grade: Grav~ depth beneath pipe Township: I Range: S~tion: Fill add~ above originel grade: Grovel length: I I  Number of line,: Di.~ betw~n lin~ ~ New G Upgra Gr~velwidth: ~,¢/ Ft. ~' ~¢¢ Pt~ Clarification (Priva~ ~- Cas~ To; Total ab~rptlon area: Pipe matedah Yield: / Pump Set at: Casing ~~d: __~ ~ ¢~.~ TANK SEPARATION DISTANCES ~s~i~ ~ ~o~d~ ~ S.T.~... TO Se¢flc Ab~rptlon Li~ Holding ~Private Manufacturer: Capsci~ in ~allons: From Tank Reid Station Tank 8ewerLin. ~~ ~ Sudace ~ _ w~t.~ ~ LIFT STATION Line Foundation ~, ,0' ~' "Pump on" ,eve, a~~~ ~ater a,arm ,,: -- Cu~ainDrain__~ -'~. ~ ~ i El~tri~~ lPump Ma ~ El~trical Inspections pedormed by: Remarks: BENCH MARK Location a~d Description: Assumed Elevation: ~ ~[. ENGINEER'S SEAL /,~ '. BRENT P. EATON : ,~ Department of Heal~ apd Human Se~ices approval ¢~%". CE-9126 Reviewed and approved by' Date'/¢-//~ ¢~ %%¢ ~OFE~9 100' WELL RADIUS B~ LOT 4, DE SPIRITO SU. "'~%,/ ,_..-: .. / ~C PAVEMENT/ X ID I ~ABANDONED TRENCH ~ ~PVC SEPTIC VALVE ~C01 A CO2 -~1,250 GAL SEPTIC TANK ~ST1 ~ 4 BEDROOM ~' ~ } ~ HoME ( ~ ~' RETAINING WALLS LEGEND s e.,5~'4o- ~ + WELL 155.00' o STAND PIPE (CLEANOUT) NOTES: ~ TRENCH DRAINFIELD NO SURFACE WATER +100' · MONITOR TUBE NO KNOWN CURTAIN DRAINS PAGE 2 OF 5 SEPTIC PLAN ASBUILT ~ OF LECAL: LOT ~ FOUR WAYS SUBDIVISION~ ........... BRENT P EATON P.E *~'.. ~-'~ ..'~ · , · ,, ~'.. ..'~ 3801-A WILSON STREET ~h~¢;" .......... :~ A~CMO~AG~, AK 99503 P~. 229-3777 /5oo.49', -c¢,-r / ,495.99 .502.07 500 88 -Tn-`/--/--~1/ ..... I.'/~'~'°~ /494,05 /494.10 /492.58 ~ ' ~ / / ~%o ~ ~OoX ~oO N 490.23/ "% ~o a ~" o ~490, 8 / °" ° ~ ~o o GARAGE SLAB "~"~.~ ~" ~ ' "B5'67~ ~ ~-~ ) .o o" 485,64 ASSUME ELEVATION = 500' o ~ ~ ~.% o% x~ 490.2 . ~ 474.7 SEPT C PROFILE ASSU LT LEOAL: LOT 4 FOUR WAYS SUBD~VIS~ON ~.... ow,E~. DE~E: ~EXW~,~E~ DATE: 10/10/95 NOT TO SCALE ~/~,~.E~O, ..'~ BRENT P EATON P.E ~,'¢~.. o~-~ ..~ 5801-A WILSON STREET ANCHORAGE, AK 99505 PH. 229-5777 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 NUMBER:SW950295 DESIGN ENGINEER:I~k~MMY GeMeA~$~Q~ n~ OWNER NAME:REXWINKEL DARREL J & LINDA OWNER ADDRESS:6732 E 99TH AVE ANCHORAGE, ALASKA 99516 PAGE 1 OF PARCEL ID:01508204 PERMIT DATE ISSUED: 9/27/95 EXPIRATION DATE: 9/27/96 LEGAL DESCRIPTION: FOUR WAYS LT 4 LOT SIZE: 48000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. PROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL P ROVI~~ RECEIVED BRENT P. EATON, P.E. CIVIL ENGINEER 3801 A, Wilson S~reet * Anchorage, Alaska 99505 * Phone 229 5777 September 20, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Subject: Lot 4, Four Ways Subdivision Dear Mr. Cross: The proposed septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +50' distance. 3. The design is an upgrade to an existing surcharged system. 4. Drainage will not be affected and is not a major consideration in my design. I will be on site several times throughout construction of the proposed improvements should there be any change in below ground conditions that would require a design modification. If you have any questions please call me at 229-3777. Brent P. Eaton, P.E. ENVIRONMENTAl. SERViCEs DIVISION RECEIVED C:~ PE~STU FF~DOC UM E NT~,SAGGS~IARR,DO C BRENT P. EATON, P.E. CIVIL ENGINEER 5501-A Wilson Streel * Anchorage, Alaska 99505 * Phone 229-5777 BPE Project No.: 95-02 Calculated By: BPE Date: Sep. 20, 1995 Legal: Lot 4, Four Ways Subdivision Test Hole No. 1 Single Family, 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation Rate = 20 minutes per inch Wastewater application rate = 0.6 gallons per day per square foot Required absorption area = 1,000 square feet Gravel depth = 7 feet Required length = 72 feet Total Excavation Depth = 14 feet E~/ii~ONMEixI~A~ SERVICES DiViSION RECEIVED C:~BP E~STU FF~DOC U M ENT~SAG G S\CALC. DOC 100' WELL RADIUS U~B, ~ LOT 4, DE SPI~RITO S t '~ . , / ~ PROPOSED TRENCH (2 EA ) N__ ~ ~V ~ ~ TYPICAL W/ ' ~ ' / ~ /I / MONITOR ~BE / ~[~/ Y CLEANOUTS (2 EA.) '~ ~~ ~ ~__~o/~/'/.~/ /I TOTAL TRENCH LENGTH v j- ~/ _ ~ J SEPTIC TANK ~ ~ ~ ~X~ ~ J ~ ~ ~X UNDER RETAINING WALL LEGEND + WELL s ~'~'~o' ~ ~ TEST HOLE 155,00' o EXISTING STAND PIPE: ~ ~t~ ~ ~ ~ ~ PROP, TRENCH DRAINFIELD NOTES: ~L~'~O ~ NO SURFACE WATER +100' uM-~ ~U~ M~ ~ * PROPOSED CLEANOUT (CO) NO KNOWN CURTAIN DRAINS ~, · PROPOSED MONITOR TUBE SEPTIC SITE PLAN ~ O~..AL~. LEGAL' LOT 4 FOUR WAYS SUBDIVISION OWNER' DERREL REXWINKEL DATE: 08/19/95 SCALE 1 = 50 B R E N T P E A TO N P E · ~ . . 5801-A WILSON STREET ANCHORAGE, AK 99503 PH. 229-5777 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16- 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? ~,~/A po E 8epth lo Waler AFter,, ~oniloring?I"~/A Date: _S_¢(~, t~,, q~ SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN ._ HR, ~ (m~nutes/,nch) PERC ROLE DIAMETER ~:~ _FTAND 7 ._FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: <:~'~'~ 72-00R fray 4/RRI BRENT P. EATON, P.E. ,}801 A Wilson Stred* Anchoroge, Alasko 9950,5 * P' one 229 5,/77 BPE Project No.: 95-02 Calculated By: BPE Date: Sep. 20, 1995 Legal: Lot 4, Four Ways Subdivision SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM MUNICIPALIIY OF ANCHO~:,~' I:NVIRONMENTAL SERVICES DIVISION RECEIVED GENERAL The well and septic plan are for a single family residence only. The drawing and or site plan shall be a pad of this specification. All materials and workmanship shall meet the Municipality of Anchorage Department of Health & Human Services requirements. All soil tests are advisory to the design and are to be verified in the field by the Engineer. All excavations and depths are advisory and are to be verified in the field by the Installer to meet Municipality of Anchorage requirements. It is the responsibility of the owner to obtain all necessary permits or easements and to locate all adjacent multi-family wells. The excavation is to be exactyl in the area shown on the site plan, any deviation requires Engineer approval. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. DEEP TRENCH 2. 3. 4. 5. The bottom of the trench shall be level, plus or minus 0.1 feet. The total depth of the trench excavation shall not exceed 14. feet, The sewer line shall be level, plus or minus 0.03 feet. The trench gravel is to be covered with geo-textile material. The area over the trench is to be finish graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100 feet to any exising private well, 150 feet to any Class "C" well, or 200 feet to any community well. Note: Twenty-four (24) hours notice required for all inspections. C:~BPE~TUFF\DOCUMENT~^GGS\SPEC.DOC MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2:04-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT [P.ONE ~AME MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS PERMIT NO, Well DISTANCE TO: I Manufacturer Liq. capacity in gallons ~ / IWell DISTANCE TO: J Nm of lines , J Length of each hne ~f~/ I T~pe of crib ~ Depth [ ~T~ B uild,n~ fou.datio~ Absorption area '[ Dwelling / Material Inside length /Widtl~ Dwelling .J Material Foundatioa Nearest lot line Total length of lines /Trench width ! Material beneath tile ~ f Depth No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines inches PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank / Absorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER ? REMARKS APPROVED DATE LEGAL J J:::Ziil'.!. J.':! hi',:!. F:i?.tl;: hj:::.¥':: ':::?t) I:!i!:;i:!::)l.lI.,!!::, l'::lJ",l[) q'H!: l!llZ!;ifi: JZti; N(:t :;!i':': I,I:[PTI'! i'I'E:Z (:ii.:i:FF/F:i:L [:,!i:F:'TH :l::i; Fi-il: Fff',!!'::, "I[.11!: l",(J'l'!'!::li"l !),!;: l'"l :! i"! :[ I'I1. I!"i f)]1: 1!; I'Ft!",IC:!:: liirl.!:l'!,!l!:h!:'.,! i:;:1 !,.I1:1 .t I':INI:', F:li",!"r' ()N.-.'h; :!: :!Eu}i F:'!!:I::!' I::()I:i: I:t I::'t:;i::(',,,'F::f'!'I~i l,.If::!_l...; :;!.!:!i~i!1 I'O ;~i:!;:l~;+il I::li:l::l I:::'Fi:OH !::', F'U!i',!.:!:(:: !.,11:1 i [::,[i:!::'l:_::I.,!!::,:l BIG l,.![i:L!. I~O(!i'!ii; Fti;i:!:!:: !:;ii[!!Z:!l..Ij:l:;i:l:::!) F':IN[) 1'!1.1:!;'1 I!:',E ?;:it::i:TIII:,i:i'.,!I::D '1'(! O1:: i!"t1!: I,lli::l..!.. (::O1"!!::'1 .E!' I: (J l'l Il! t;:: ?;i:[:i:(:!l.j :!: I;i:!{!"!!':N !'::{i; !"i1::!"~' l::l?i::'!..'d. :~i;t:::'FJ:: ]:!::: :[ I::1:::I: ]:l)t'.,]?i; F:ff',![) (?:)i",!:!i; I !;;?.I(i: I l: l:li'.,! l::, :!: f::l(:i:tF!i'i:;; '::!!;::i:: !' :l ',,,' !:::! J: t FII:i',!..t: l() ]: i'.,I :: !; I. IF:!: !:'F:(')P[::I:R [ N':ii;Tl:::li t. .. I:::! T :I: j:;it i' ZI: l;"i' 1'1 'ii:::! -! !:t1"! i::'!::Ii'"t):i.):FIt:;i: HZ(Ti'! '!'I!!:: t,~:l::(::!l_l:(l:;i:llil'iELl'-.l"l':::i; FOI:,:: (iN' ::;[ I"!:i7 ?;!i:!,ll:!iF;?':!; l::ff',ll) I,.!',::::! ! ::!: i::!:::: ;!;r: '.' !:?,"r' TI"IF: HUN :!: !'.I :l: !...i.. :[ i",!'[!;'t I::'![ !. ! .!!",1 I)[:!: l;i! :!i; T i:::l i",!!)!'Hi::'t I D!i!!Z?',!(::!:i: I. i:i:; !;i:i:!"!E!!)!i::l E i:::1F:'!::'!.. :i: (:: !: :~] !::' FI!::i: !:,~: !{ !:;::Ii:: Nlq :[ i",~I(I: I PERFORMED FOR: LEGAL DESCRIPTION: 1 ~-~,2 3 4 5 6 7 8 9 10 11 13 14 15 16 17 18 19 20 COMMENTS E~ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'[ SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST DATE PERFORMED: .,~'~.-/ /'~/ /~7~ .~; 2~, SLOPE SITE PLAN F- I r ~ ] T -T ; 14 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) ~ FT CERTIFIED BY: 72-008 (7/76) ---"40~ ¢A/:Pt ~J3 AS-GUILT NO CORNERS SET THIS DATE EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED 1¢"~2 "794 PLAT ARE NOT SHOWN HEREON. MUNICIPALITY OF ANCHORAGE DEPT. OF HEAl_TH & ENVIRONMENTAL .PROTECrlON APR 2 11986 RECE1VE.D I hereby certify that I have performed a Mortagee's in- spection of the following described property: ~ Anchorage Recording Precinct, A]aska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadxvays, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this ~'~ff'~ day of-3(~k-/~ 19 7~ FRED WALATKA & ASSOCIATEs Engineers and Surveyors Certified Well ~or. ...................... ~ ~ ~: ~.:L.~. ~..x..~.~.~?.;~ ....................................................... :~ocatio, ............. ~e.9..:....: .,....4......w...a.~..s....5-:?. L...5~.:~.O...:.:.a.:~ .:....5.:..:.s..!5.~ Date completed....._qg.'.J:,Y._~.....2:..c~..~..?. ...................................................................... Del,,b o: wen ......... ..:.3..4.: ......................................................................................... 6" ID Size of casing ............................................................................................................. Distance to water ........................... .~...9..~ ...................................................................... 114 ' Distance to water while pumping ............................................................... at rate of ............... 3-00 .................... gallons per hour. Description of Formation from to Loose gravel & sand 0 10 Brown till 10 13 Brown olay & sand , , 13 73 Brown till 73 93 Till w/gravel strea~, ,wet 93 I 99 Brown silt 99 108 Fine sand & silt - wet, 108 122 Till w/fine sand & gravel, w:t 122 134 ,~ater, sand & gravel I certify the above true and correct. DOTTEN DRILLING John's Road SPENARD, ALASKA CO. We advise you to attach this certificate to your deed. . · ~, -:;;7:: ' . ~', ':," C :?':.:, :: . ' ' ' : ;' "' :!' ' :,;'5:' :::~ :: ': .5 "?.- ' ", ,.i , : ~ ':'5 ?'L';: w, ': 7,, ,, ." ~ ' i- ':'" :t : :':, :.%~:': ~:. ,:,?. ,,."' i · . "'"' ~ ' ' ~ ~ · ~: '" -,:.'t ' :~ :..::::~::.,: ~¢,':,.:.: o' ::.:: .:.. :..-' · . :: / ~ - .. 4':'.~: s. )~:, .,,o25::~.':5~::?.:.:.:~::::.:: ::.., ::'::::.::. '~' Municipality of Anchorage Development Services Department' Building Safety Division On-Site Water and Wastewater Program ' 4700 South Bragaw SL. P,O, Box 19665~) Anchorage, AK' 99519-6650 www, cLanchorage,ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D, : 015-082-04 '1. GENERAL INFORMATION .. Complete legal desCription T_. ~ t Location (site address or directions) .. DctO' .OL. Expiration Date:. _~ - ,,~ j~--- O/-1L. 6732 S, 99t:h Ave, ' Current Property owner(s) Mailing address Lending agency Mailing address Jim DiHagR:rLo Day phone 222-8881~ Residential Hortgage 1300 W. Benson /1200-Anchorage, AK Day phon~ 995o~ Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be held by ,DSD for pickup. NUMBER OF BEDROOMS: Z~ Day phone TYPE 'OF WATER SUPPLY:" Individual Well ~ Individual Water Storage [] Community Class ~ Well [] Public Water System ['-I TYPE OF WASTEWATER DISPOSAL: · Individual On-site Individual Holding tank Community On-site ~ Public Sewer E] I The Municipality of Anchorage Development Services Department (DsD)' Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. e STATEMENT OF INSPECTION BY'ENGINEER ' As certified by my seal affixed hereto and as of the validation· date shown belowl I verify that my investigaiion, based on Procedures outlined in the Health Authority 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 S' & S Engineering Address 17034 N. Eagle River Rd. Ste. 204' Eagle Engineer's Printed Name ' Robert C. Cowan *bedrooms. DSD SIGNATURE t.-" ApProved for Lp "Disapproved. . Conditional approval for Phone 694-2979 River, AK 99577 Date ..... :..;.. ,. , ~ ~ % ~O~T C COWAN ~ ~ bedrooms, ~th the follo~ng stipulations: ' Additional Comments Attachments: · HM Checklist Septic System Advisory Well Flow Advisory X (Rev. 01~32) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Legal DesCriPtion: :L(~:T 'i F,~o ,'t "'. ,i: Municipality of Anchorage ':Dev~el°pment serviceS ~DePartment i' i . i' ~ : ' Building Safety DiviSion. ': i :i ..~ On-Site Water & Wastewater Program ', ~ ~' ' ~4700 South Bragaw St.~ 'i P.Q. Box 196650 Anchorage, AK 99519-6650 : ~ ~ ;www.ci.anchorage.ak.us ,. : ' i i:' ~. (907) 343-7904 HEALTH AUTHoRiTY AppRoVAL CHEc.KLiS 'deisth in absorpbon field before iestP'~Y'i!in. 'Water added6¥{:!;gai.I, :i ~ ~ . ': !Elaps me~-GO'~min. ~, .. il Finalfluidde~th~ o in Abs'°r ti6n rat~ ,= g.p.d.~- ~-n~ r~ 12 mo.) (YIN &., ,:Iffy s.' gwe date We!!tyRe ;J~ v~lr~ . ,...:i;: IfA. B, or, C provide PWSID # . 'Well Log '~N). Wires Properly ~r)tected AT INSPECTION: Cohfo~ . ~ O colomes[~00,~. : Nitrate ~, 31 ,mg/I.' : Other bactefi~ Arse~~ ~, ~.::~ , Date of sample ~/' ¢/~ ¢: Collected b~'~ 5'& .................. ~ No. 2O .ianKsize ~l~a'u'.:gal:, ~:;I".;~Nd~berrofCompa~mentS ~ ' cleanobts IN foun~a~gp;cleanoutON),y,~'.jiDePressiori:over tank (Y~ No -. H gh watera [~m (y~ ~ o ABSORPTION FIELD DATA :~,,'~:. , ; ' . . :-:. ,,' , :~TotaldePth':'l,3 ft .:Effabs~'r'tionarea)~)~f2 . .. .~ :..~ I ' : . ,, ~. , . ,. . ,.. .,. ,.p. . t . Momtonngtube- .J :D( )ress~onoverfield. Parcel ID: D. LIFT STATION Date inStalled "Pump on" level at in. Datum ~ ....~-~'~ycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL'ON LOT TO: :Septic'tank/lift station on lot ' ) o o -f- .. Absorption field on lot ) o 0 '-/- Public sewer main ·/J//,4 ' ' Sewer/septic service line . ' ~5"' --/-- "Pump off". level at ' .~igh water alarm level at Meets alarm & circuit requirements' in. / ~o On adjacent lots On adjacent lots 'Public sewer manhole/cleanout 'Holding tank , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: - Building foundation 5- -/- Water main /v. Wells on adjacent lots / o O Property line ~' "'J" Water service line JO z..j_ . · Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:, · Property line /O ~ ' Building foundation Water Service line ! o '.-/'. Surface water J o o ""-~' ' Cudain'drain/,/0,,/~. K',,.f4~,,,/ Wells on adj~ceni. 10ts ) a o '--/- F. COMMENTS Water main Driveway, parking/vehicle storage' ENGINEER'S' CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA 'guidelines in effect on this date'; Engineer's Printed Name ~)~'7-- C. Date ' ,~ / ~ 0 HAA Fee..$ ~ ~ O. ~'" Waiver Fee $ Date of Payment "~ / ~' o //o' t7 ....... Date of Payment. Receipt Number O .~- a 5"o ?J ~ Receipt Number (Rev. 12/01) ·. . , L (~ I?' · t3 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE REOORDBD PLAT, ARB NOT SHOWN HEREON. "ASBUILT" No corners set .! THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTION8 SPECIFICALLY TO SHOW "ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLa,Ti'ED LOT LINES OR EASEMENTS AND I$ NOT TO 8E USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. Anchorege. Ateska ..... /_,~ &tA~__ 2_~ ~._ ....... I hereby certl~ that I have sun/eyed the following described property, Lot_.~ Block - / , /?~/..I,~ ,,,[~,,,,:l y'..5 ~..'./J.~....~..., Anchorage recording district Alaska, and that the Improvements situates thereon are within the property lines and do not overlap or enoroaoh on tho property lytng adJacenl thereto, that no Improvements on property lying adJaoent thereto encroach on the premises In question and that there are no roadway, fransmle~on lines or Other visible easemenle on aald property except aa Indicated hereon. CT&E Environmental Services Inc. 200 Sq. Potter Drive Anchorage, AK 99518-1605 Telephone: (907) 562-2343 Facsimile: (907) 5(51-5301 Drinking Water Analysis. Report for Total 200 W. Potter Drive Coliform Bacteria Anchorage, AK 99518-1605 .RE,4DJI~f~,~,UCTIONS OI? ~SE ~E ~FO~ CO~CTIN~ SA3IP~ ' Tel: (907) 562-2343 ........... Fax: .{907} 561-5301 MUST BE COMPLETIiD BY WA'ItfK SUPPLIER 13 PUBLIC WATER SYSTEM I.D. # I I I till sys M ~ Sendlnvoice SAMPLE DATE: ' .l~$ontb SAMPLE TYPE: Routine tn Repeat Sample (for rout. the sample with'lab rgL.no. ) El Special Purpose SAMPL~LqCATIO~ Comments: · Day Year Treated Water Unltreated Water Time Collected 'Collected ' TO BE COMPLETED BY LABORATORY Analy.::is shows this Water SAMPLE ~o be: 'l~ Satisfactory o Unsati.sfactory .. o Sample.over 30 hours old, results may be unreliable ' 0 SamlSl6 too l~3ng in' transit; sample should not be.over~otrrs old'at examination to indicate reliabl~ results. Please send .s~e~¥: sh.mple via special delivery.mail. 5'-lq-ot~ !7c 5. Date l~eceived Time Receivcd Analysl~ Began Analytical Method: t,. Membrane Filter ' MMO-MUG _,/A__) mi. 1042650 -, , Sent to A.D.E.C. Anch Fbl~ Date: Time: . . Clien't notified of.unsatlsfacto~ resuli~ Phoned Spoke with Date: ~im~: BACTERIOLOGICAL 33/ATER ANALYSIS .RECORD ~ __ C~loniesnt~0 mi BGB · COLIFIRM M~O-MUG Result: Total C~liform Membrane Filter: Direct Count · Verification: LTB Fecal Coliform Confirmation Final Membrane Filter Results Reported By- .~'~..~'~ c~. 'Z, -.~Zt--~'V/ Coliform/100 mi Analyst Jun [] Fazed Fazed TI~I'C- Too Nurnn~tt~ To Count OB - Other Boctoqa Member ofthe SGS Group(Soci6t6 G6n6rale de Surveillance) SGS Ref.# Client Name Project Name/# Client Sample ID Matrix' Sample Remarks: ! 042650001 S & S~E,~gi~eering Lot 4SFour Ways SID Lot 4 Four Ways S/D Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 05/18/2004 11:34 Collected Date/Time 05/14/2004 15:00 Received Date/Time 05/14/2004 17:05 Technical Director. Step. h .~'C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nit~ate-~l 4.31 0. I00 mg/L EPA 300.0 B (<=10) 05115104 JJB Microbiology Laboratory To~al Coliform col/100mL SMI8 9222B A (<=1) 05114104 DKC 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 ... Location (site address or directions) Property owner Mailing address Lending agency Mailing address 'F. o. 60¥ Day phone Day phone Agent Address Day phone Unless otherwise/'equested, 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. TYPE OF WASTEWATER DISPOSAL: 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 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 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 I2~¢--?-F4-F ~/~'T(:~ Phone ~'"Z'c/- ~'7 "7 '7 Address ¢¢0/~ Engineers signature ~ ~/~*/~'~.-~ Date DHHS SIGNATURE ~</ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Corn ,nts Date The i', ic~pality of Anchorage Departmer~t of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent proi'essional 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 1tgl) Back MOA ~,21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICI=S Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA Well type l?,~c~ Log preseut (Y/N) _ Total depth 1~ d( t Sanita~ seal (Y/N) Date of test Static water level Well production FROM WELL LOG ,2Yt-t ~"( / '/9 Parcel I:D.: _ If A, B, or C, attach ADEC letter. ADEC waler systeln number Date completed Cased to N~o~ ~, Casing height (above ground) Wires properly protected ~) AT INSPEC~ON g.p,m. 199r~. Other bacteria Number Of Compartments g.p.m. ____ Cleanouts (Y/N) High water alarm (Y/N) WATER SAMPLE [LESULTS: Coliform ' O - Nitrate Date of sample: Or~'T · [~o/ c)~ Collected by: B. SEPTIC/ItOLDING TANK DATA Date installed I O/c)~ 'Funk size Foundation cleanout (Y/N) "/~ Depression (Y/N) Date of Pumping I~]~ Pumper C. ABSOR~ION FHgLD DATA Date installed [O{~ ~ Length ~d at 41' Width Effective absorption area 1,4¢2-% ~,q¢¢' Monitoring Tube present(Y/N) "{,¢~q Depression over field (Y/N) Llo Date of adequacy test ,O/[l~[a?~ Results(Pass/Fail)*/~% For ~ bedrooms Soil rating (g.p.d./fl: or ft2/Mrm) O, ~ System type ~'~'-I ~-' ~ / Gravel thickness below pipe lc> ! Total depth hnmediately afterb~P, gal. water added (in.): Absorption rate = _ b3/P' g.p.d. If >,es, give date. ~ / Fluid depth ill absorption field before test (in.); Iq/P, Fluiddepth t4/A .(ins.) Minutes later: ~//~ Peroxide treatment (past 12 months) (Y/N) ~ O D. LIFT STATION  Size in gallons Manhole/Access (Y/N) ~ "Pump on" level at* ~p of[" level at* High water alarm level at* ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main tM On adjacent lots On adjacent lots Public sewer maahole/cleanout ' / Sewer/septic service line } OO Lift station V-~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line I~ Absorption field ~ OCD/ Water mai~se~ice line ~ Surface water/drainage ~{ ~ Wells on adjacent lots SEPARA~ON DISTANCE FROM ABSOR~ON FIELD ON LOT TO: / r Building foundation ~O Water mai~ffsemce line Surhce water ~/~ Ddveway~ parkin~vehicle storage area Curtain drain ~ ~ Wells on adjacent lots [O~ Property line F. ENG~EER~S CERTIFICATION Engineer's Name ¢~[~' ~. , ..... .......................................................................................................... ....... HAA Fee $ ~ ~ Waiver Fee $ Date of Payment ~ ~ / F~ ~}~ Date Cf Payment ~eceipt ~umber /~~~) ~eceipt ~umber Rev. 8/95 OSS: haa.wk.doc 00T-18-95 NED 13~37 R~IN PROOF ROOFING ~A~oN, ~y Name F~X NO, 9073493388 P, 01 CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Raport ~R~M W~ S S~GOT WOR/~ Order 18933 ~inCed Daze Technical Director Sample P~marks: SAMPLE COLLRCTED BY: B.E. WIT~$ED DY J,S. Nitra~e-N $,~ m~/L EPA 35~,2 10. 10/1~/9~ CMN * See Special Ins~u~tion~ Above UA '' See Sample Remarks ABove ~A ~ ~ot ~alyzmd ~.= Seuonda~ diluGion. GT ~ Greater Th~ 200 ~. ~o~e~ Odve, Aoch0rase, AK ~9~18-1 ~0~ -- Tek (907) 5~2-254~ ENVIRONMENTAL FACILI?II~S JN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS. MARYLANO. MICHIGAN. MIg~OURt. N~/ JERI~EY, OHIO. WEST VIROINIA 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 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name __g¢~f~_~'Jm I<~ lC Telephone: Home __~,,~G 2 702. Business Applicant Address __,~_~_¢___~ ........ (c) Applicant is (check one): Lending Institution [] ; Owner/builde~ ; Buyer [] ; Other [] (explain); (d) Lending Institution _ ~")¢-t_( /' ¢' (c Telephone Address (e) Real Estate Cornpany and Agent ~///) Address Telephone (f) Mail the HAA to the following address: ;~7oZ / TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms '~' Other WATER SUPPLY Individual Well,~ Community [] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite R 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. 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 Address Date WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply, ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This tlealth Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system, Construction data reported on buried system components is from MOA files and was not verified during this inspection. DHEP APPROVA.L. ~//¢ ['~ ¢~.//~_----/__ . ~2 Approved ~/ Disapprov~ Conditional Terms of Conditional Approval Date 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 § 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. . Paqe 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~- ~' r'~UlNIL, IPALII¥ OF ANCHORAGE DEPT, OF HI~ALTH & ENVIRONMENTAL PROTECTION RECEIVED WELL DATA Casing Height Above Ground __. Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Well Classification ~ $ If A, B, C, D.E,C. Approved (Y/N) Well Log Present (Y/N) _ ~/ Date ComCeted 7 / '~ Yield Total Depth /~ '~ _ Cased to ~_~~._. pept.~ of Grouting U ,, ~.~n~..~ Static water Level ~ .7 tL¢.~) Pump Set At 1 ~ n+ Sanitary Seal on Casing (Y/N) ,.,v Depression Around Wellhead (Y/N) t 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 Water Sample Test Results ; On Adjoining Lots j O~ _; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ; Date B. SEPTIC/HOLDING TANK DATA Date installed /~/"7_~ Size /,~,~J-O No. of Compartments Standpipes (Y/N)~ (-{~) Air-tight Caps (Y/N) _ Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~[ Date Last Pumped ~./'2 Pumping/Maintenance Contract on File (Y/N) /L2//~ ; for Holding Tank High-Water Alarm (Y/N) __ /v/ //4 _ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line _ To Water Main/Service Line Course To Building Foundation 2.,¢ + To Disposal Field _ /¢2 'P To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Type of System Design "/ ¢¢. ~ ¢-.~ Soils Rating in Absorption Strata / ~--~ Date Installed ~/"7 ...9 Length of Field '~ ~ Width of Field o ~s ~ '~r'¢, '~.-E Depth of Field ~. Gravel Bed Thickness ~ / Square Feet of Absorption Area ~ .2,/4 () t~f,~_~'~',~ ,4~¢ Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ /-~ ~,-~r-w~ $ Separation Distance from Absorption Field: / To Water-Supply Well I O~ To Property Line /~ To Building Foundation ~¢-~ --+ To Existing or Abandoned System on Lot /~//~ ; On Adjoining Lots ~¢~¢f¢', To Cutbank (if present) To Water Main/Service Line .1¢~) '~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,./ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitt~/~Bedro~,m Rating Against HAA Request ** I certify t ha~,,.l'h"~ze~.J~ec"J~e/~~onfor reed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~Z/~, J/' ,,'~~ Date MiL(/~ ~/~ ~ MOA No. Company Receipt No. Date of Payment' Amount: $ Page 2 of 2 72-026 (11/84) ALASKA FIUIRODmSDTAL COFITROL $SRUIC $, IF1C. ~n§Jn¢¢rin§ 6 ~nuJronmcntoJ $1udics 07/21/82 MUNICIPALI'I~ OF ANCHORAGE ENVI,: ,~;. I ,A. f .o E ;: I J U L ~ 3 19,.q2 RECEIV D SAFECO/PAT GRANELLE 3201 C. STREET SUITE 101 ANCHORAGE ~d( 99503 SELLER - SCHUTTE BUYER-CARLSON SUBDIVISION-4 WAY SUBDIVISION BLOCK-1 LOT-3 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 432 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 900 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 7/21/82 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 4 BEDROOM HOUSE. ~i~, ~ro~, R~id, Jr, ~ J~ 1250 IS ADEQUATE FOR 1220 U Jest 25i'h Jtvcnu¢ · ]\nchoraq¢, Alask~ 99503 · (907) 276q361 A, IUNICIPA .~7Y OF AN~'~H©~AGE MUNICIPALITY OF ANCHORAGE DEPT.  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECI'I~/IRONMEN]AL 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIREOTION~ Complete all parts on page 1, Incomplete requests will not b~ processed, Please allow ten (10) days for processing, ERTYOWNER MAILINGADDBES8 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3, LENDING INSTITUTION k ] PHONE I MAILING ADDRESS 4. REALTOR/AGENT ~ _ PHONE MAILIN~ ADDRE88 .n! ..(? 5, LEGAL DESCRIPTIOn? Lo¥ y STREET LOCATION / / 6, TYPE OF RESIDENCE NUMBER OF BEDRO(..~JVIS ,~ [] One ~ Four SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY '~" 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 wel [] PUBLIC UTI LITY depth (attach log f available.) 8. SEWAGE DISPOSAL SYSTEM ~::~// ~ INDIVIDUAL/ON-SITE** ** f individual/on-site, give installation date "7 ~, f system is over two (2) years old an adequacy test is reouired [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONL', DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~SI NG LE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO E~/FOU R [] SIX PERMIT NUMBER 2. WATER SUPPLY [~INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, i~ND AGE DISPOSAL SYSTEM PERMIT NUMBER IVI DUAL/ON -SITE DATE INSTALLED ~PUBLIC UTILITY Connj~ction Verified ,~ INSTALLER [~eptic Tank or E~]Holding Tank Size: /~-O If Tank is homemade SOILS RATING give dimensions: / TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line I Absorption Area to nearest Lot Line 5. COMMENTS [~"APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco~[~any certificate) DISAPPROVED / / DATE BY (Ti t,~FJ~ // L EGA L D~ESC R ~P~/~"/~')~ ~'~ ~-~ F ~ / ,~ 72-010 (Rev, 3/78) September 10, 1979 barrel J. Rexwinkel Star Route A Box 33-B Anchorage, Alaska 99507 Subject: Lot 4 Fourways Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) A well log submitted ~o this department. (2) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. If therd are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First Federal Savings and Loan Association % Richard Ansley Post Office Box 4-2200 99509 g~