HomeMy WebLinkAboutBENITO BLK 3 LT 8Benito
Lot 8
Block 3
#050-272-16
Parcel I.D. #
MUNICIPALITY Of ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
050-272-16
1. GENERAL INFORMATION
Completelegal description BENITO SUBDIVISION: LOT 8. BLOCK
Location (site address or directions) 17227 BEAR PAW CIRCLE EAGLE RIVER. AK 99577
Property owner
Mailing address
Lending agency
Mailing address
CHRIS BROWN
17227 BEAR PAW CIRCLE
Day phone
EAGLE RIVER. AK 99577
Day phone.
(907) 266-1134
Agent BERT DOZART W./ REMAX PROPERTIES Day phone (907) 257-0162
Address 2600 CORDOVA STREET. ANCHORAGE. AK 9950,5
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide wfitten confirrnation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer xxx
NOTE: ff community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc.. shaft be paid $800. O0 at,
or prior to, closing for the engineering services provioed. J
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 Authodfy 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 vedfy 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 ts in compliance with all Municipal and State codes, ordinances, and regulations in effect
on the date of this inspection.
Name of Firm ALASKA WATER
Address 6901 DEBARR ~/t
Engineer's Signature ._~.
In conducting this evaluation,
system in accordance with ADEC and MGA
-'_ ~B'~/,~N(~HORAGE, ALASKA 99504 .
~V~ ~- Date
~ted tO,p~bvide a thorough, conscientious engineering analysis of the
Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being seAzed by the system. These conditions are outside the control of
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for tile sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or parly is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
--//'~-Approved for ~ bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
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 ¢Y21 Computer Version
i :CEIVED
Municipality of Anchorage AUG 03 2000
DEPARTMENT OF HEALTH & HUMAN SEJI~41~$~
Environmental Services Division .....
825 "L" Street, Rm 502 Anchorage~ Alaska 99501 (907) 343-4744
Health Authority Approval Checklist
Legal Description:
BENITO S/D; LOT 8, BLOCt~ .3,
Parcel I.D.: 050-272-16
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
Total depth 84'+
Sanitary seal (Y/N)
NO Date completed
Cased to 40'+
YES
If A, B, or C, attach ADEC letter. ADEC water system number N/A
APPROX. 1975
Casing height (above ground) 12"+
Wires properly protected (Y/N) YES
FROM WELL LOG
Date of test ~
Static water level ., L_-~~7/
Well production ~ g.p.m.
AT INSPECTION
7/28/00
81'
5.2
g.p.m.
WATER sAMpLE RESULTS:
Coliform 0
Date of sample:
7/28/00
Nitrate
1.51 mg/L Other bacteria 0
Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size ~, Nl~mL~-~__.~ments' ~!e~21~~
Foundation cleanout (Y/N) alarm (Y/N)
Date ~ Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ff2 or ff2/bdrm) System type
Width Gravel thickness below pipe~
Length
~ _.._.....
Effective absorption area Monitoring Tube p/'¢~'_ ~t (Y/~D~-''~'- Depression over field (Y/N)_
Date of adequacy test ~~Fail), ,O.\F~u~lt "" Fail) ForFor ........ Bedrooms
Fluid depth in ab~· r ~a.lwater added (in.): __
Fluid depth (ins) Minutes later: Absorption rate =
~nt (past 12 months) (Y/N) If yes, give date
72-026 (Rev, 3/96)* Computer Version
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons__
"Pump on" leve~evel at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot PUBLIC SEWER
On adjacent lots
100'+
Absorption field on lot PUBLIC SEWER
On adjacent lots
100'+
Public sewer main 50'+ Public sewer manhole/cleanout 50'+
Sewedseptic service line
25'+ Lift station N/A __
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO:
Foundation i Q ' .
Wat ' ' ' ~- Surface water/drainage Wells on adjacent lots__
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
F. ENGINEER'S C.C/B
I certify that I~av
of Municipa~/reco
with MOA ~/,4A
Signature
Engineer's Nam
Date
~/T'he~,~ field inspections and review
e systems are in conformance
;t on this date.
JEFFREY A. GARNESS
Wells on
adjacent lots
HAAFee$ ~ O-o
Date of Payment
Receipt Number /~5--~.~h ( ~/'-~'~-*'~
72-026 (Rev. 3/98)* Computer Vemlon
Waiver Fee $
Date of Payment.
Receipt Number_.
06-01-06 16:15
FRO~-CTE EflVI RO~I~flTAL
CT&E Environmental Se~i,'es Inc.
56153O1
T-106 P.01/02 ~-810
CT&E Ref. s
Client Name
Project Namem
ClieaT Sample ID
Matrix
Orderad By
PW$1D
Sample Remarks:
1004156001
AK_ WaTer & Waxtewater Consultan~ ]nc.
Bemto S/D Lot S Blk 3 FdB
Bemto S/D Lot 8 Bllc 3 H/B
Drinking Water
Client PO~
Priated Date/Time 08/01/2000 15'58
Collected Date/Time 07/28/2000 14:45
Received Date/Time 07/28/2000 15:40
Technical Dire~or STephe. C. Eric
Parameter R~5~as PQL Units Me,od L:m,t~ Da{c Date h6t
Ninate-N
1.5! 0.500 rag/L EPA 300.0 10 max 07/28/00 SCL
Total Coliform
0 ¢ol/100mL SM18 9222B 07;28/00
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. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address /,/. 2~<zx/.Z~, ~-~'5.~c~' 5/r'~' ~,
Lending agency
Mailing .address
Agent
Address
Day phone f:¢o~ ~ ~ ?~: -- ~<?~
Day phone
Day phone 6, ??" ~/'Z~'
=
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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#21
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
Address
Engineer's signature
David R. Dayton P.E.
20210 Donaiar St.
DHHS SIGNATURE
~ Approved for "~'"~'~ ~'~) bedrooms.
Phone
Date
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze.data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev. 1/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type J~ U~'~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
,~ Date completed / ~'?~ Driller
? / ~ Cased to ,~,~ ~ Casing height
Y
Wires properly protected (Y/N)
FROM
Date of test ~"./~5"
Static water level
Well flow
?
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot /"~//~-
g.p.m.
AT INSPECTION
g.p.m.
; On adjacent lots
131
; On adjacent lots
Public sewer main
Sewer service line ~..5
WATER SAMPLE RESULTS:
Coliform
Public sewer manhole/cleanout
Petroleum tank
Nitrate
Other bacteria
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Collected by: _~
/L,J//~ Tank size
Foundation cleanout (Y/N)
Compartments
Depression (Y/N)
Alarm tested (Y/N)
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
On adjacent lots
Foundation
To property line
Absorption field
Water main/service line
Surface water/drainage
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Date installed
Length Width
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Manufacturer
Soil rating (GPD/FF)
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
Bedrooms
System type
Total depth
Depression over field (Y/N)
for
After test
If yes, give date
On adjacent lots Property line
To existing or abandoned system on lot
Cutbank Water main/service line
Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
l~v|d. R. Dayton P.E.
20210 Denalar St,'
Chugiak, Alaska 99567
HAA Fee $
Date of Payment
Receipt Number
' '' 1: i:'~r, , ~,,~.0.%~' .~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
D. R. DAYTON, P.E., R.L.S.
h~x~~~ Chugiak, Alaska 99567
20210 Donalar
(907) ~I~-~T~:~
696-2417
September, 30, 1993
WELL FLOW TEST
Legal Description: Lot 8, Blk 3, Bonito Subd.
Date of Test: September 28,1993
Well Depth: Unknown - exceeds 91'
Casing Depth: Unknown - Exceeds 40'
Static Water Level: 85'
Requirements: 3 BR - 450 gallons per day
Test:
The well was tested with the existing pump through an outside
hose bib. Volume and drawdown measurements were recorded at timed
intervals.
Results:
The well produced 741 gallons in 125 minutes at a flow rate
of 5.93 gpm.
The total drawdown was 6'. The drawdown was fully recovered
within 14 minutes after pumping was stopped.
The well is currently producing adequately for a 3 BR home.
COMMERCIAL TESTING &
s.~cE,9o~ REPORT of ANALYSIS
Chemlab Ref.~ :93.5076-3
Client Sample ID :L8 B3 BENITO SUB.
Matrix :WATER
ENGINEERING CO.
5633 B STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name :DAVID DAYTON, P.E.
Ordered By :DAVID R. DAYTON
Project Name :
Project~ :
PWSID :UA
Sample Remarks:
ROUTINE SAMPLE COLLECTED BY: D.R.D.
WORK Order : 71438
Report Completed :09/29/93
Collected : @ 13:45 hrs.
Received :09/24/93 @ 16:30 hrs.
Technical Director:STEPHEN .C. EDE
Released By : ~ ~/~,~,~-~,~-,~
TAG MARKED SAMPLED 0N~-25-93
WE RECEIVED SAMPLE ON 9-24-93.
R~ .....' QC
Parameter ~sult_~_Qual Units
Nitrate-N i? -~i~ mg/L
Allowable Ext. Anal
Method Limits Date Date Init
EPA 353.2/300.0 10
09/27 CMR
* See Special Instructions Above
** See Sample Remarks Above
U = Undetected, Reported value is the practical quantification limit.
D = Secondary dilution.
Member of the SGS Group (Socibt~ G~n6rale de Surveillance)
UA = Unavailable
NA = Not Analyzed
LT = Less Than
GT = Greater Than
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
1.¸
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date / / - /
GENERAL INFORMATION
(a)
(b)
(c)
Legalpescription (incl!jde lot, b[gck, subdivision, section, t/ownship, range)
Location (ad.~ress or directio~ , -
Applicant Address
Applicant is (check one): Lending Institution
(d) Lending Institution /"J ~-~ ~ /~''' Telephone
Address
(e) Real Estate Company and Agent :':J "~ 7~7'?~
Address ~ ~"~ -
(f)
Te~!ephone
~'K~he HAA to the following address:
TYPE OF RESIDENCE
Single-Famil¥~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Welf.~ Community [] Public []
/.
Note: If community well system, must have written confirmation from the State Departmer~t of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPO~,~
Onsite [] Public/~ Community [] Holding Tank []
/ .
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
5. 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 ~:, ,~,",L~ ~'RIVER,,A~S~
PH,
Date
Telephone
DHEP APPRO_~.
Approved for (.,~1,,'c~..2..~ bedrooms by
Approved ~x~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE.
DEPT. OF HEALTH & '~
ENVIRONMENTAL PROTECTION
Iv'JAY 0 7 1985'
Legal Description:
WELL DATA
Well Classification
Well Log Present
Total Depth ~..-~k./
Static Water Level
Casing Height Above Ground /~.' ~ ("~-
Electrical Wiring in Condui~L/~N)
~'~ r~, _ Jf A, B, C, D.E.C. Approved (Y/N)
Date Completed /~'73 Yield
Cased to ~'~ t~
· Depth of Grouting
Pump Set At
Sanitary Seal on Casing/~'~jN)
Depresmon Around Wellhead (Y~
Separation Distances from Well:
To Septic/Holding Tank on Lot /L///~. , / ' On Adjoining Lots
To Nearest Edge of Abso~ion Field on~,ot~ /~J//'/~ · On Adjoining Lots
To Nearest Public Sewerage /~ ~ To Nearest Public Sewer
Cleanout/Manholec~ 7¢ / To Nearest Sewer Service Line on Lot
Water Sample Collected by ~,'~ (~ ~"~.,4'/,))~'~_./'/,~¢ ~' ; Date
· r ,,,.~,~ (/ · - /
Water Sample Test Results ~-~
Comments ~ 0 ~' C /..,. E 7'7'~'~"d' 0 ~ ~ ~3~/~_,,~ ~-'~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)' Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~ /
Pumping/Maintenance Contract on File (Y/N-) /~j
Holding Tank High-Water Alarm (Y/N) /,/ '
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
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 P/J'/~ L.., ~ (-.-- ~'~__,, k,,,,~/~
Page 1 of 2
72-026(11/84)
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
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
j..Standpipes (Y/N)
Present
Date of Last Adequacy Test
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) .
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
"Pump Off" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify.that I have checked, verified, or conformed to all MOA and H. AA g.ui.~.delines
Si ned S & ~ E?~tGINEER]N~ .~-"/~/~5
g ~ , ~H~ 195~ ' Date ~ / ~
CompaH~ ,~,LE RIVER, A~SKA '9~577 MOA No ~ ~O ~
Receipt No. ~ ~ I ~
Date of Payment ~'-~-~5~ '
Amount: $ ~
Page 2 of 2
72-026 (11/84)
in effect on the date of this inspection.
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
274-2533
May 7, 1985
Mr. Robert Shafer
S ~ S Engineering
SRB 196X
Eagle River, Alaska 99577
SUBJECT:
Waiver Horizontal Separation between Well and Septic Tank,
Lot 8, Block 3, Benito Subdivision, Eagle River, AK.
8521-WA-145
Dear Mr. Shafer:
The Department has reviewed the subject waiver request and hereby
temporarily waives the horizontal separation between the well and
septic tank to 79 feet on the subject property for a single family
residence only.
This temporary waiver will expire in 90 days. The waiver will become
permanent upon as-built information showing that inlet and outlet sewer
and any construction joints within the manhole have been hardened by
grouting with a waterproof material.
Si ncerely,
SE/dd
Steve Eng, P.E.
District Engineer
,MUNICIPALITY OF ANCHORAGE
DEPARTME OF HEALTH AND ENV]RONMENi
825 L Street, Anchorao~, Alaska
264-4720
PROTECTION 99501
Date Received: March'20, 1978
Date ~.-~Q~/~ ~ O}~u~s Date
Insp ~ ' Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: LSecurity Pacific Mortgage Co~ora~ion
Mailing Address: 1011 East Tudor Road, Suite 190 Phone: 276-1933,
Property Owner: Marshal Carr Phone:
Mailing Address: Bear Paw Circle 99577 , ,.
Legal Description: Lot 8 Block 3 Benit0 Subdivision
694-2682
4: Single Family Residence: (x)
Number of Bedrooms:
Three
Multiple Family Residence: ( )
Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
Permit #
Depth of Well
Well Log on File ( )
Construction
Bacterial Analysis
6. Sewage Disposal System: On-site System ( )
Permit # Installed
Public Utility~)
Installer
Septic Tank Size ..... Manufacturer
Absorption Area ,. Soils Rate
Material
7. Distances: Well to Septic, Tank
to Sewer Line Nearest Lot.line
to Nearest Lot Line
to Absorption Area
Absorption Area
'Page Two~~ '- '
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 8 Block 3 Benito Subdivision
Comment s: ·
Affadavit Attached: /~ Letter Attached: ( )
//
Approved:
Disapproved: Date:
Department Worksheet:
I t6I '~dV
os ................................................ :-
-
J
'0N ONY 13]BIS
]lVO ~0
~UV~LS~d
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
FiiA ur C°nve!'~Cionai
nloska ~te Lank
~1~ E..i;orti~er)~ L. iqhts ~ivd
Laqle River
Phone:
Phone:
block
Type of facility to be inspected
Well Data:
A. Type i!~-i~i~.~
C. Construction
7. Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
8, Distances:
A. Well to: Septic tank
Nearest lot line
1. Size
1. Absorption Area
Total length of lines
No. of bedrooms
B, Foundation to septic tank
C. Absorption area to nearest lot line
B. Depth
D. Bacterial Analysis
Pui~l ic S~Jer Systei~
B. Installer
2. Manufacturer
2.
, AbsOrption area
, Other contamination
, Absorption area
Material
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - R~ ~st for Approval of Individual ver & Water Facilities
Comments
Approved~~ E ~-~ ~,~'~' Disapproved Date ,/l~l-'7:
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA /FHA
2. Property Owner: ~/)/J (~AJ'~~ ~
Mailing Address: ~ JL~ ~)~ ("V,
3. Name of Buyer: ~~~ ~~
Mailing Address, ~*~ ~~~ DayPhone:
4. Name of Lending Institution: ~ .... ,,-h. ~ .
Mailing Address: / ~.r{;L ¢'~LL'r~)'. /:.ia~'i~.A ~e:
5. Name of Realtor or Agent: ~ ~O_~
Mailing Address: ~< ~' ~'~ .ho.e:
6. Legal Description: ~ ¢, ~ ~ ~¢~ ~
Day Phone:
Type of Facility to be Inspected:
No. Bdrms. ~
8. Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
If Individual, date of installation
72-003(3/76)
MUNIC"IP&LIT¥ OF ANCttORAG~.
ENV' I~VlNMLi'''1 t/"~1,, I~OTFaGTIOI~
1978
RECEIVED
A~ICHORAGE/W1ESTE~N DISTRICT OFFICE
437 'E" STREET, SUITE 303
A~CHORAGE, ALASKA 99501
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
274-2533
May 7, 1985
Mr. Robert Sharer
S m S Engineering
SRB 196X
Eagle River, Alaska 9~577
SUBJECT:
Waiver Horizontal Separation between Well and Septic Tan~,
Lot 8, Block 3, Bentto Subdivision, Eagle River, AK.
8521-WA-145
Dear Mr. Sharer:
The Department has reviewed the subject waiver request and hereby
temporarily waives the horizontal separation between the well and
septic tank to 79 feet on the subject property for a single family
residence only.
This temporary waiver will expire in 90 days. The waiver will become
pemanent upon as-built information showing that inlet and outlet sewer
and any construction Joints within the manhole have been hardened by
grouting with a waterproof material.
Si ncerely,
Steve Eng, P.E.
District Engineer