HomeMy WebLinkAboutBENITO BLK 1 LT 1Bcnito
Lot 1
Block 1
#050-271-31
GAAB-HD I b~
GP~4TER ANCHORAGE AREA BOROI.'
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-~.511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS
LOCATION
C~-~ o ~ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL
CAPAC,TY
GALLONS.
MATERIAL ~.~c~ I ~ NUMBER OF
COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
/
LIQUID
DEPTH __
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR W,DTH /¥
DISTANCE FROM WELL~ /'
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH //~ji~, ., DEPTH
__, BUILDING FOUNDATION__
'"~'~"~/'~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
FOUNDATION.
~ ~'/f'"'"~-~~L LE~NGTH
NEAREST LOTC~-/~E OF LINES
NUMBER OF LINES
DISTANCE BETWEEN LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE.
IN. ABOVE TILE
WELL: TYPE ~ DEPTH / ~ ~J
LOT LINE ~-'~! NEAREST 7.~.~-- / SEPTIC
SEWER LINE , TANK
DISTANCE FROM '~O WATER
, BUILDING FOUNDATION. SAMPLE
g~.~ ! SEEPAGE
SYSTEM //S ! , CESSPOOL
NEAREST
OTHER
, SOURCES__
DISTANCES:
DATE
APPROVED
· ( HEALTH AUTHORITY
er ifiei) 3rilli g
DOC Co. elba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
&
OWNER OF LAND
ADDRESS
LEGALDESCRI~ION Z / /~ [
DATE- Started
PERMIT NUMBER
DEl'TH OF WELL '/ 7'~'
STATIC LEVEL OF waTer e'r. ,.
I)RAW DOWN FT.
GALS. PER HR
KINI) OF CASING
/&oo
KIND OF FORMATION:
From 0 Ft. to '~ Ft. (' ~,,/$ , ,~a( ,~"T'/<.~(O9'~
From _~) Et. to .~ Ft. OO~ d, od4~
From ~ Vt. to '~ ~ Ft. ~4~d ~e~;~ C~d~
Fromm. Ft. to Ft. ~I 1 3 &-O
From '~ '~ Ft. to g7 Ft. ~ ~ ~ ~4~4
From ~ Ft. to ~.Ft. C~ ~ <ed~
From. ~& ~t. to /~ ~. ~-~-~ ~ ~<d~& ~
From / o ~ Ft. to l,~g Ft. ~4d~-~
F~o~~Ft. to I$: Et. ~/~ ~d~L
From~Ft. to .Ft. ~EL -~
From ]~ Et. to /~g Ft. ~{6~ .~4-~ ,
From /~ Et. to lTL Ft. g~r ~4~ .
Fromm. Ft. to .Ft. ~ ~d~g~ ~ ~ ~
From~Ft. to Ft. ~4 ~
From~Ft. to Ft.
From~Ft. to~ Ft._
From ~. Ft. to Fl
From.~ Ft. to . ..Ft.
From Ft. to Ft. .,.
' O~ ~c~O~
From ~lK¥.~'qcu~ !~ ....
Ft
From F~ -- Ft.
From ~Ft. to Ft.
From ~Ft, to ,Ft.
From ~ Ft. to Ft.
From ~Ft. to ,, _Ft.
From Ft. to , .Ft.
From Ft. to ,.Ft
From~Ft. to__Ft.
From Ft. to Ft.
From Ft. to Ft.
MISCL. INFORMATION:
DRILLER'S NAME
SLIBD I V I S I ON: BE:I',I I 'T'O
F,r..f ........ :I. 2 ,
::>,::: ..... t :1: ON ',~ T'OWI',I,EiH I P ,,
:LiT/'()O (SQ,, 1:::'"1' ,, OR ::::::::::::::::::::::: )
LOT: 1 BI...OCI<: 1
1 41',I RANGE': ~: 2W
:i: ,;::: e i- 'l'. :i. f y t I"i a'l:..:
'.[ ~, iJl .:..'::rr~ ,~:' ..::':di'i :i. ]. :i. ,.':'i: P W ii. 'i'.. h 'I:. h ~:.:-:, p (::.:, qL.~ :L P 6::~fil,BF~ '{:. !:::. i' (3 r' (:'.:q"i '."',:ii: :i. '[ (.::::, !:::- 6:.:, ~,',~ (.:.).', r" :i:: afl (i:t
fc'.,i"'!'..h l::iy 'I'..t'-1,:.:.:.:, Mur'i:i.c::i. pa.l.:i.t.y of:' Ar'ic:h,'.:;i!',age (I"."IOA) ar'id the S'La'l:.e c::,l:' A:l. asl.::a,,
;':::~.,. :1: ~.,,::i.:l.l. :i.l"ista:l.:i. .l: l---j (.=::, :i:.;y<.i!i,I.'..em :i.r] aC:i;::(::)l"(::l,:i:'d"tC:i:-:.: :,,.~:i't'..l"i a:l.:l. M/::h:'.:~ C;i;:;'(::l(.:.)':'i!i
<':'::riCl :i, ri CCif.,'ipii.:i.a';i:C:!:.;.:, v,~:i.'t:..h ti"i(:.;.? cl(.:.::,!::i:i, gr'i ,::::r':i. tc:.:r':i.a of tl"i:i.,;:!i
:::!; ,, :I: ~..,~ ,i, t :!,a (:l t'"~ <,:,! l", (,?:.) '('.i:i <';ii. :J. :[ I"tOA 6?~.l"icJ ~::;'t'..Y::.i'[',.(.::.:, ci-i:' A ]. a'::iJ.::a 1" (.:.:.:,c:jt..,'. :[ p (,:.:.? fl'i e l"l '{'., :::.;
(::! :i. ::::::::::::::::::::::::: [' :' c)m any e::< :i..:::-;'L :i. i'":(.:'.j we I 1 ~, waste~,x.:.~.'!:.(::,r, ,.'::l :i_ :.::t:::,osa i sysL(:.::,m ,::::,~', t:::, :. d::) I :i.::::
E:. (,:.) I,':J E::, P 6':i (:,:j :} ':iii 'y' <,:i: 'l,:, i<,Hii C)I'] J:.h :i. ':::: C)I'" <::Fly aCJj .:::i(:::6:,l'"it (:]P l 'i (.:.:, a !" J::iy ]. o'{:..
7/.:='
· --'- /0
1
i hereby certify tl~l' I han, o s~4ry~ci the ~llowing de~ribed prope~, Lot ~ ~k *
.... '' recording Precinct, ~a~a, and that lhe
fi unicipahtYof
Anchorage
P.O. B,.,X 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 23, 1986
Kenneth Rourke
Box 100 Genora Street
Eagle River, Alaska 99577
Subject: Lot 1 Block 1Benito Subdivision
On-site Well Permit #860073 - Issued March 17, 1986
On May 20, 1986, The Anchorage Assembly approved a new ordinance
regulating on-site wastewater disposal systems (septic systems).
Ail septic systems constructed after the effective date of this
ordinance are subject to the provisions of this ordinance.
Our records show that you currently hold a permit for the installation
of a septic system. We strongly urge that you contact this office
prior to constructing your system. Any changes in the code that could
impact the construction requirements of your septic system will be
identified and brought to your attention. Please contact the
· Environmental Services Division at 264-4720.
Thank you for your cooperation.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/SSM/ljw
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On~Site Services Section 825 "L" Street Room 502
RO. Box 196650 Anchorage, AK 99519-6650
www, oi.anoho rage.ak,us
(907) 343-4744
Parcel I.D. 050-27~-31
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date:
Lot 1, Block 1, Benito Subdivision
Location (site address or directions) 1 0 01 1 Genora Street
Current Properly owner(s)
Mailing address
Donald & Dorothy Jensen Dayph0ne
13520 272nd Street NE Arlington, WA 98223
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherw se requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
Three (3)
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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 less than 30 days old. Cedificates
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.
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 11/7/00
.¢" £;t,,: .,~N¢[~EER S -' ',
DHHS SIGNATURE '~ ,*" ~,~,¢.,,, .", ,'~ ....
~ Approved for ~ bedrooms, ';~ v:;k, ';~;¢~",¢ .- :.; ;-- ,.,¢
Disapproved
Conditional approval for bedrooms, with the following
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: ?.- ~;'~ ¢ 4:5
Original Certificate Date:
Reissue Date:
Legal Description:
( -JMunlc pahty
· ' ' of Anchorage
Department of Health and Human Servl~e~
Division of Environmental Services ,~. !..
C E I V E D
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us NOV 0 8 ;[000
(907) 343-4744
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL C H~ENTAL SEEVlCES DIVISl0N
Lot 1, Block 1, Benito Subdivision
IfA, B, or C provide PWSID #__
Sanitary seal ¥
Cased to
FROM WELL LOG
3/86
A. WELL DATA
Well type Private
Date completed 3 / 8 6
Total depth 1 75 ft
Date of test
Static water level
Well production 20
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi
Date of sample: 10/30/00
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Date installed
Cleanouts
Date of pumping
C. ABSORPTION FIELD DATA
Date installed.
Length __ft
Total depth __
ft
g.p.m
Parcel I.D.:
050-27-31
>40 ff in.
Well Log ¥
Wires properly protected ¥
Casing height (above ground) > 24
AT INSPECTION
10/30/00
118 ~
4.5
g.p.m
Nitrate .5 mg/I Other bacteria__
Collected by: M~.A
- Municipal Sewer System
Tank size
Foundation cleanout
0 colonies/100 mi
gal Number of Compartments __
Depression over tank __ High water alarm __
Pumper
Soil rating (g.p.d./ft2 or ft2/bdrm) __
Width __ft Gravel below pipe __
ft Effective absorption area ft2 Monitoring tube
Date of adequacy test __ Results (Pass/Fail)
Fluid depth in absorption field before test __ in Water added
Elapsed Time: rain Final fluid depth in
. Any rejuvenation treatment (past 12 mo.) (Y/N & type).
System type
ft
__ Depression over field
For bedrooms
gal. New depth
Absorption rate >=
.If yes, give date __
in.
g.p.d.
72-026 (Rev. 01/00)*
LIFT STATION - N/A
Date installed
"Pump on" level at __.. in
Datum
E. SEPARATION DISTANCES
F.
Size in gallons __
"Pump off" level at
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lotN/A
Absorption field on lot N/A
Public sewer main > 100'
Sewer/septic service line > 25 '
in
Manhole/Access
I--ligh water alarm level at in
Meets alarm & circuit requirements__
On adjacent lots > 100 '
On adjacent lots > 100 '
Public sewer manhole/cleanout > 100 '
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line
Water service line
Wells on adjacent lots
Building foundation
Water main
Drainage
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
N/A
Absorption field __
Surface water
- N/A
Building foundation Water main
Surface water Driveway, parking/vehicle storage __
Wells on adjacent lots __
Property line
Water Service line
Curtain drain
COMMENTS
Second Well
On Lot Decommissioned
and State Requirements.
G. 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 Michael E. Anderson, P.E.
Date 11/8/00
h City
· !77
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)'
11-06-0,0 17:30 FRO~,t-CTE ENVIRONMENTAL
~t~ C T&EEnvironmentalSe
rvlces IRc,
56]53el
T-343 P.O2/03 F-624
CT&E Ref.# 1006778001
Client Name Anderson Engineering
Project Name/# Lt 1 Block 1 Benito
Client Sample ID Lt I Block l Benito
Matrix Drinking Water
Ordered
PWSID 0
Client PO#
Printed Date/Time 11/06/2000 16:15
Collected Date/Time 10/30/2000 18:30
Received Date/Time 10/31/2000 9:40
Technical Director Stephe~ C. Ede
ReleasedBY~~~
Sample Remarks:
Allowable Prep Analysis
Results PQL Uni~ Meflmd Limits Date Date Init
Nitrate-lq 0.500 U 0.500 mg/L EPA 300.0
10 max lOI31100 SCL
Microbiology Laboratory
Total Coliform
colllOOmL SM18 9222B
10/31/00 KAP
Received - me Nov. 6 5:33PM
Lot 1, Block
· . '. ' Benito
~...- -. · . ,. - : . ·
.. i
Main
5 ¢ SITE PLAN
~ -1 "-~1 0 0.'
'NO_ SO '~-5 I '
45O
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 Ill ~1
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
SEc
Location (address or directions)
(b) Applicant Name VAt_.I-,~NT Telephone: Home Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution ~l~,~, C.I ~'1 C. ~..~L. O Telephone
Address
(e) Real Estate Company and Agent
Address e~-O'7
Telephone
(f) Mail the HAA to the following address:
~' /~o/Z.T H ~. G.~N I~J~T ~
S' g e- am' yjl~ 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 [] 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 I of 2 72-025 {11/84)
5. ENGINEERING FIRM PROVIDII~G INSPECTIONS, TESTS, FILE SEARCH, D~ I'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.
Name of Firm -~. -~.~~ Telephone
Address ~ -~ ~ /'~ ~
Date Al, l
Engineer's Seal
DHEP APPROVAL
Approved fOr
Approved
Terms of Conditional Apprpval
Disapproved
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 (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
NOV 2
264-4720
Legal Description: LoT I T"O
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ! 7--~ Cased to
Static Water Level I~.
Casing Height Above Ground .p_ I~ '1
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line '75
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N)
Date Completed J~b~.c~4 lq ~c) Yield ,~.C) c~ c~v'Y1
/'7,-,~' Depth of Grouting
Pump Set At ~ oTTO
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
' On Adjoining Lots
:~/""~ ' On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
; Date I II
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pure ping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Su pply Well
To Property Line
To Water Main/Service Line
Course
Size No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
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 Ar~,-~
Comments
LIFT STATION
Date Installed '~ ~'~
Size in Gallons
"Pump On"/~ ~at
Tested ~:.
Electricl~l Code-, ~Y/N)
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
, To Property n~/_ ~
Adjoini'\/r~ Edts/ V To Existing or Abandoned System on
;
On
..-., ,~?u'~nnk (if present)
V
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** 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
Company _"~. ~ MO^No.
Receipt No. "~' '~ '~ ..... '
Dine of Payment
~ , . ,,-. . ...... ~./, Engineer's Seal
Amount: $
Page 2 of 2
72-026 (11/84)
Form Approv*d
FHA.~orn~ 2373 e U. S, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget Bureau No. 63-R296.8
Rev. July= iV58 FEDERAL HOUSING ADMINISTRATION
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATEE SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--tO BE COMPLETED BY FHA
~NSURING OFFICE MORTGAGEE SERIAL NO,
MORTGAGOR OR S~NSOR PROPER~ ADDRESS
SUBDIVISION NAME "--~ ...... ' ~-- J~CK NO. JLOTNO.
TOTAL
NUM~RI
Can ~c ~ o~er aNa be modo
~ ~ew installation a~lflonal b~oms?
BASEMENT
uw~o umTs ilOROOMS B*THS~,
(If Yes, how manyJ)
z
Wl~l SUPPLY BY: SYSTEM DlSlGNED
~ Public system-- ~ ~mmuniW system ~ Individual .o. oF .DR.s
~ ~blic system ~ ~mmunity system ~ Individual ~. ~ Yes ~ No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPE~OR'S SKETCH
~ ~ ..... ~ ~---
~ w ............ ~_~_~
It is the opinion of the ~ State ~ Counw ~ ~cal Department or Health that this individual
water-supply
~ is ~ is not satisfactory as a domestic water supply for the subject pro~rW.
It is the opinion of the ~ State ~ County ~ Local Department of Health that this individual
sewage-disposal
sys-
tem with proper maintenance:
~ Can ~ exp~ted to function satisfactorily, and ~ ~nnot be exacted to function satisfactorily
is not likely to create an insanit~ condition
NOTE: The heo~ auth¢l~ should, complete the appropriate opinion statement above and a~x date, signature ,nd title In the
spaces provided./ / .
Use of the above grid 'for Health Department Inspector's sketch as well os use of theback 0f this f°rm~is at the option of th~
heal~ authority.
PART Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UN~RWRI~R:
I have r~iewed the foregoing and the ~ninent FHA Complim~ce Ins~ion Report, and reco~end that the
Individual water-supply system ~ considered ~ Acceptable ~ Not Acceptable
~wage dis~sal ~ conside~d ~ Acceptable ~ Not Acceptable.
DATE SIGNATURE ~ CHIEF ARCHI~EC~
DEPU~ F~ CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA FOrm 2S73
Rev. July 1958
'61
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March 25, 1975
File No.: 4-1
GrEATL.. ANCHORAGE AREA BC.. :)UGH
3330 CSTREET,
ANCHORAGE:, ALASKA 99503
DEPARTMENT OF' ENVIRONMENTAL QUALITY
274-456 !
Mr. Kenneth Rourke
P.O. Box 100
Eagle River, Alaska
99577
Dear Mr. Rourke:
It has been brought to our attention that public sewer is available to
Block 1, Lot 1, Benito Subdivision.
According to Greater Anchorage Area Borough Ordinance, Chapter 16,
Article 16.45, Section 16.45.050:
"Septic tank-seepage system sewage disposal facilities shall not
be installed or used on any premises where sanitary sewers are
available within seventy (70) feet of the nearest lot line of
said premises ...".
The Greater Anchorage Area Borough Public Works Department has
checked their records and they indicate that your structure (s) is
not connected to the sanitary sewer. Would you please check your
records to verify that the structure (s) is or is not connected and
notify us immediately if your records indicate that a connection
has been made.
If we do not hear from you within seven (7) days, we will assume that
our records are correct. We, therefore, .request you connect any and
all structures located on the subject property to public sewer during
the 1975 construction season.
You must apply for a connection permit from the permit officer for the
Greater Anchorage Area Borough, 3500 East Tudor Road. If you have
any questions regarding the above, please do not hesitate to contact
the permit officer at 279-8686, extension 259, or the Department of
Environmental Quality at 274-4561, extension 141.
iver District Sanitarian
JL/lw
RECEIPT FOR CERTIFIED MAIL--30~! (plus postage)
SENT TO POSTMARK
OR DATE
STREET AND NO,
P.O., STATE AND ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
~TURN ~ I. Shows to whom and date delivered ...........
With delivery to addressee only ............ 65¢
RECEIPT 2. Shows to whom, date and where delivered ** 35¢
SERVICES With delivery to addressee only ............ 8§¢
DELIVER TO ADDRESSEE ONL~Y .............. :. ........................ : ..........
SPECIAL DELIVERY (oxtro fee required) ....................................
PS Form NO INSURANCE COVERAGE PROVIDED-- (.,C:ee other side)
Apr. ILO)?! 3800 NOT FOR INTERNATIONAL MAIL ~a]~o:Jg?2 0-460-?42
D~ar Mr. Rou. rko~
It has been bFoMiiM to om, aReniS~ that publio sewer is available
L~ 1. ~Ioek I. B~nito 8abdtvislo~.
A~eoTdt~ ~o the ~unielpal Code or O~ "Sewage
~a~er 16, Arth~le 16.4S, Seeitem
iF~alled or ~used~ou aulg pl, JmJsee whe~ oanfia~ eewere at'e available
1~ we do not bee~ from ymu wtthin seven fi) days. we will assume tbet our records
the ~~ut ~ ~ ~ h~m~ ~ ~ ~~.
RECEIPT FOR CERTIFIED MAIL--30(~ (plus postage)
SENT TO POSTMARK
OR DATE
STREET AND NO.
P.O., STATE AND ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN
RECEIPT
SERVICES
[ 1. Shows to whom and date delivered ........... -/5~'~
With delivery to addressee only ............ 65¢
2. Shows to whom, date and where delivered .. 35¢
With delivery to addressee only ............ 85~ I
DELIVER TO ADDRESSEE ONLY ...................................................... 50~
SPECIAL DELIVERY (extro fee requir®d) ....................................
PS Form NO INSURANCE COVERAGE PROVIDED-- (See other side)
Apr. ]~)71 3800 NOT FOR INTERNATIONAL MAIL ~ GPo: ]972 o- 460-743
Tax Code;
GREATER .A.N. CHC~O~AGE AREA BOROUGH
D ~._ TEST
""'-i'~ate:_'
Mailing Address:
User / Tenant:
Property Address;
Subdivision:,
'DYE TES T:
D Positive
[]. Negative
~' ADDI I'/ONAL INFORMATiON:
Fie/d:
Adm/n/$fered By:
~ PW-062(7-74) ~ C~.~-
